Anatomy of the Stomach and Surrounding Structures, Part II: For Those Who Value Practical Knowledge

Abstract

Precise understanding of clinical anatomy comes from precise understanding of embryology. Senior colleagues who make such statements probably have never opened embryology textbooks such as Moore’s “The Developing Human: Clinically Oriented Embryology” or Langman’s “Medical Embryology” but are very good surgeons. A knowledge of embryology is indeed needed, and in this chapter we not only consider embryology but also focus on a slightly different approach to gaining practical knowledge to inform our surgeries. The master carpenter, when building a palace, requires an accurate drawing. But creating a plastic model—a precise miniature of this palace—requires only standard preshaped parts straight out of the box; parts just need to be assembled sequentially from top to bottom, which can be done by anyone with glue. In surgery, if we have a basic understanding of the complex three-dimensional structure of the stomach and surrounding structures (adnexa)—akin to knowing the standard parts needed to assemble a model—we can omit certain theoretically important steps or include them later when needed. In this chapter, we explore the anatomy of the stomach and adnexa, where individual parts are assembled sequentially from deep to superficial. We emphasize only structures that are recognizable as membranes in practice, omitting those strictly defined embryologically such as the retropancreatic fascia and the fusion fascia in the retrocolic spaces. This chapter therefore suits to those who want to learn practical aspects of surgery.