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The Venous Trunk of Henle (Gastrocolic Trunk): a Systematic Review and Meta-Analysis of Its Prevalence, Dimensions, and Tributary Variations

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The Venous Trunk of Henle (Gastrocolic Trunk): a Systematic Review and Meta-Analysis of Its Prevalence, Dimensions, and Tributary Variations Clinical Anatomy (2018) Review The Venous Trunk of Henle (Gastrocolic Trunk): A Systematic Review and Meta-Analysis of Its Prevalence, Dimensions, and Tributary Variations TOMASZ STEFURA,1 ARTUR KACPRZYK,1 JAKUB DROŚ,1 MICHAŁ PĘDZIWIATR,2,3 2,3 4 PIOTR MAJOR, AND MATEUSZ KRYSTIAN HOŁDA * 1Students’ Scientific Group at 2nd Department of Surgery, Jagiellonian University Medical College, Cracow, Poland 22nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland 3Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Cracow, Poland 4Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland Surgeons have recognized the clinical significance of the venous trunk of Henle during multiple pancreatic, colorectal, and hepatobiliary procedures. To date, no study has followed the principles of evidence-based anatomy to characterize it. Our aim was to find, gather, and systematize available anatomical data concerning this structure. The MEDLINE/PubMed, ScienceDirect, EMBASE, BIOSIS, SciELO, and Web of Science databases were searched. The following data were extracted: prev- alence of the trunk of Henle, its mean diameter and length, the organization of its tributaries, method of anatomical assessment (cadaveric, radiological, or intrao- perative), geographical origin, study sample, and known health status. Our search identified 38 records that included data from 2,686 subjects. Overall, the preva- lence of the trunk of Henle was 86.9% (95% CI, 0.81–0.92) and the mean diame- ter was 4.2 mm. Only one study reported the length of the trunk (10.7 mm). The most common type of venous trunk (56.1%) was a vessel comprising three tribu- taries: gastric (right gastro-epiploic vein), pancreatic (most commonly the anterior superior pancreaticoduodenal vein), and colic (most commonly the superior right colic vein). The trunk of Henle is a common variant in the anatomy of the portal cir- culation. It is a highly variable vessel, but the most common type is a gastro-pan- creato-colic trunk. In surgical practice, the presence of this venous trunk poses a high risk for bleeding, but it can also be a useful landmark during various abdominal procedures. Clin. Anat. 9999:1–13, 2018. © 2018 Wiley Periodicals, Inc. Key words: anatomy; meta-analysis; evidence-based medicine; venous trunk; right gastroepiploic vein; right colic vein; pancreaticoduodenect- omy; colorectal surgery Additional supporting information may be found online in the Received 11 May 2018; Revised 3 June 2018; Accepted 9 Supporting Information section at the end of the article. June 2018 *Correspondence to: Mateusz Krystian Hołda, MD, PhD, Depart- Published online 00 Month in Wiley Online Library (wileyonlineli- ment of Anatomy, Jagiellonian University Medical College, brary.com). DOI: 10.1002/ca.23228 Kopernika 12, 31-034 Cracow, Poland. E-mail: [email protected] © 2018 Wiley Periodicals, Inc. 2 Stefura et al. INTRODUCTION not required for a systematic review using meta- analysis. The venous trunk of Henle (or gastrocolic trunk) was first described by Jacob Henle in 1868 as a blood vessel (vena gastro-colica) that runs anteriorly to the Search strategy surface of the pancreatic head. It drains into the right aspect of the superior mesenteric vein (SMV) on its This study complied with the guidelines of the Pre- concave border at an average of 2 cm from the con- ferred Reporting Items for Systematic Reviews and fluence of the SMV and the splenic vein. According to Meta-Analyses (PRISMA) (Supporting Information the original definition, it comprises two tributaries: Supplement 1) (Moher et al., 2009). Our strategy was fi gastric (right gastroepiploic vein [RGEV]) and colic to nd anatomical data relevant to the venous trunk of (right colic vein [RCV]) (Henle, 1868). Later, a third Henle. A wide search using the MEDLINE/PubMed, pancreatic tributary was identified, described as ScienceDirect, EMBASE, BIOSIS, SciELO, and Web of either the anterior superior pancreaticoduodenal vein Science databases was performed up to 15th March (ASPDV) or the anterior inferior pancreaticoduodenal 2018 (Supporting Information Supplement 2). We fi vein (AIPDV). Additional studies provided insights into included no date or language lters. The following multiple anatomical variations of these veins and their terms were combined using the Boolean operators “ ” “ ” tributaries, in addition to their possible confluences AND and OR and used to search the following key- “ ”“ ”“ (Reichardt and Cameron, 1980; Voiglio et al., 1998). words: gastrocolic trunk, trunk of Henle, gastroco- ”“ ”“ ’ The trunk of Henle is located in the junction between lic vein, truncus gastrocolicus, Henle sgastrocolic ”“ ”“ the omentum, the small bowel mesentery, and the trunk, Henle gastrocolic trunk, gastrocolic trunk of ”“ ”“ ” transverse mesocolon. A lack of precise anatomical Henle, gastrocolic veins, trunchiul gastrocolic, “ ”“ ”“ knowledge during abdominal surgery can result in gastro-colic trunk, gastro-colic venous trunk, gas- ” tearing of these fragile veins because of excessive trocolic venous trunk. We also performed an extensive tension, which causes massive bleeding (Kimura, 2000; reference search in the acquired articles to identify Okino et al., 2001). Surgeons have recognized the additional relevant publications. clinical significance of this trunk in various hepatobiliary and colorectal procedures. Frequently, pancreaticoduo- denectomy or complete mesocolic excision operations Eligibility assessment are associated with complications caused by injuring the Three independent reviewers performed an eligibility trunk of Henle and its tributaries during mobilization of assessment for the full-text articles identified during the transverse mesocolon from the anterior surface of the search process. At least two authors assessed each the head of the pancreas (Kapoor, 2016). However, the article. We included cadaveric, imaging, and intra- venous trunk can serve as a landmark for lymph node operative studies that reported on prevalence and/or dissection during gastrectomy or right-sided colon can- relevant anatomical data concerning the venous trunk cer resection (according to complete mesocolic excision of Henle. The trunk of Henle was defined as a reported principles), especially when a laparoscopic-assisted confluence of the RGEV with any colic or pancreatic approach is used (Tajima et al., 2011). Because it is a tributary. We excluded conference papers, reviews, highly variable anatomical structure, the trunk is partic- video articles, case reports, and studies without rele- ularly prone to accidental injury. vant anatomical data (i.e., data that did not concern The aim of the recently proposed concept of the venous trunk of Henle). If the reviewers disagreed, evidence-based anatomy (EBA) is to apply principles consensus was reached among the whole review team. of evidence-based medicine to anatomical sciences. It focuses on using systematic reviews with meta- analyses to generate weighted pooled results based Extraction strategy on multiple morphometric and epidemiological studies of anatomical structures (Yammine, 2014; Tomas- The data were extracted by members of the review zewski et al., 2017). The morphological features of team. If articles were written in a language other than the trunk of Henle remain controversial, and the anat- English, they were translated into English before omy of this vein has not been studied in accordance extraction. In studies that compared two imaging tech- with EBA principles. Our aim is therefore to find, niques, results derived from the more precise tech- gather, and systematize available anatomical data nique were considered in our meta-analysis. concerning the venous trunk of Henle, including its prevalence, diameter, length, and tributaries. We also intend to describe its surgical significance. Outcomes of interest The following data were extracted from these MATERIALS AND METHODS studies: the method of anatomical assessment (cadaver dissection, radiological imaging, or intrao- In accordance with the World Medical Association’s perative assessment), geographical origin of the stud- Declaration of Helsinki of 2013, the research was ied population, study sample, known health status of registered at http://www.researchregistry.com. The the patients in the study group, prevalence of the trunk assigned unique identifying number was “reviewregis- of Henle, mean diameter and length of the trunk, and try491.” Ethical approval and patient consent were information on venous trunk tributaries. The diameter Trunk of Henle – Meta-Analysis 3 of the trunk was defined as the maximum measured Quality of the included studies diameter of the visualized vein. There was a low risk for bias in the “design of the study” and “reporting of outcomes” domains. The risk “ Quality assessment of bias was rated high in the target and subject attributed” domain, mostly because of missing base- We used the AQUA tool to assess the quality of the line and demographic data concerning the study sub- included studies (Henry et al., 2017). The risks of bias jects. The “methodology description” domain was in the reported anatomical data for the prevalence, rated a high risk of bias in most studies because they diameter, and variations in the venous trunk of Henle lacked descriptions of the specialty or the experience were deemed “high,”“low,” or “unclear” by assessing of investigators involved. Some of the included arti- each study using five domains (characterization of cles contained
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