The Trunk of Henle and its Variants

OJECTIVE: In colon, pancreatic and hepatobiliary surgical research, an increasing interest developed in the Gastrocolic Trunk of Henle (GTH) due to its broad variability and its importance especially for right hemicolectomy with complete mesocolic excision. The purpose of this study was to further corroborate details of the anatomical variants of the Gastrocolic Trunk, in particular with respect to pancreaticoduodenal veins and the jejunal drainage into the superior mesenteric vein. METHODS: In 15 cadaveric bodies the venous drainage into the superior mesenteric vein was dissected first in a ventral, in situ approach as well as by a subsequent dorsal approach following careful abdominal exenteration. RESULTS: The most frequent configuration was the tripodal gastropancreaticocolic trunk (GPCT) with an occurrence of 54.5%, followed by the gastropancreatic trunk (GPT) with 36.4% (figure 1). The right gastroepiploic vein was a constant structure draining into the trunk of Henle in 100% of the cases. During the dissection of the pancreatic drainage, a previously undescribed, middle anterior pancreatic vein, was found in 46.67% of the specimens, which drained in 85.71% into the trunk of Henle. CONCLUSION: The trunk of Henle drains blood from several abdominal organs and bundles them into a short and vulnerable structure. The most common variant is a tripodal trunk, collecting veins from the pancreas, right colon, and the stomach. Dependent on the surgical approach, the right gastroepiploic vein or the superior right colic vein may serve as guiding structures towards the trunk of Henle. Preoperative imaging in conjunction with awareness of variants is essential for a personalized surgical pocedure. In addition, the finding of a middle anterior pancreatic vein prompts for further studies regarding venous drainage of the pancreatic head.