Division of the Short Gastric Vessels

The fundus is mobilized by dividing the short gastric vessels as this has been shown to result in less dysphagia.21 A general landmark for the caudal extent of the mobilization is the inferior pole of a normal-sized spleen. Short gastric vessels are subsequently identified and transected with the Autosonic scalpel (Tyco Healthcare, Norwalk, CT), although this can be completed with clips or other energy sources (Figure 5.2). These vessels are divided upward until one reaches the previously dissected left

Dissection Short Gastric Vessels
Figure 5.2. Transecting the short gastric vessels. (Reprinted from Hiatal Hernia and Gastroesophageal Reflux Disease. In: Townsend CM, Beauchamp DR, Evers MB, Mattox KL, eds. Sabiston Textbook of Surgery. 16th ed. 2004:755-768, Copyright 2004, with permission from Elsevier.)

crus. The vessels to the upper pole of the spleen may be very short and deep, making division very difficult without prior division of the phrenogastric ligament (left crus approach). These last vessels are best exposed by having the assistant retract the posterior wall of the body of the stomach toward the patient's right as the surgeon pulls the posterior wall of the fundus of the stomach anteriorly. A space at the base of the left crus between the lesser sac and our initial dissection along the left crus is created, allowing the more cephalad short gastric vessels to be exposed and divided.

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