Anatomy of the pre-pyloric vein and right gastroepiploic branches: Guiding the transection initiation site for sleeve gastrectomy

doi:10.4240/wjgs.117231

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 18, Issue 6

This Article

(2)

(0)

(1)

Peer-Review Report of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Supplementary Materials of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Journal Information of This Article

Publication Name

World Journal of Gastrointestinal Surgery

ISSN

1948-9366

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

- Full Article (XML)

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. Jun 27, 2026; 18(6): 117231
Published online Jun 27, 2026. doi: 10.4240/wjgs.117231

Anatomy of the pre-pyloric vein and right gastroepiploic branches: Guiding the transection initiation site for sleeve gastrectomy

Fan-Qiang Meng, Lei Zhou, Tao Tang, Xin Song, Chao-Feng Li, Hua Yang, Zong-Ze Li, Qing-Lin Li, Hai-Tao Hu, Sheng-Nan Zhou

Sheng-Nan Zhou, Hai-Tao Hu, Zong-Ze Li, Hua Yang, Chao-Feng Li, Xin Song, Tao Tang, Lei Zhou, Fan-Qiang Meng, Department of Gastrointestinal Surgery, China-Japan Friendship Hospital, Beijing 100029, China

Qing-Lin Li, Department of General Surgery, Chongqing Qianjiang Normal Hospital, Chongqing 409099, China

Co-first authors: Sheng-Nan Zhou and Hai-Tao Hu.

Author contributions: Zhou SN collected clinical data, participated in surgical operations, and drafted the manuscript; Hu HT performed statistical analysis, revised the manuscript, and verified data accuracy; Li QL assisted in intraoperative anatomical measurement and data sorting; Li ZZ was responsible for postoperative follow-up and metabolic indicator monitoring; Yang H provided technical support for surgical operation and data validation; Li CF participated in study design and constructive discussions; Song X organized clinical records and literature retrieval; Tang T and Zhou L revised the manuscript for academic rigor and language polish; Meng FQ conceived and designed the study, obtained funding support, approved the final version of the manuscript, and is the corresponding author. All authors read and approved the final manuscript. Zhou SN and Hu HT contributed equally to this work as co-first authors.

AI contribution statement: No part of the manuscript main text was generated by AI. ChatGPT was only used for language polishing and expression revision of the manuscript text. The research design and result interpretation were all completed independently by the author without any AI tools. All figures, charts and images in the manuscript are made by the author, not generated by any AI tools.

Supported by Chinese Rehabilitation Medicine Association, No. KFKT-2024-KY-001; Young Elite Scientists Sponsorship Program by CAST, No. YESS20230577; and Elite Medical Professionals Initiative of China-Japan Friendship Hospital, No. ZRJY2024-QM11 and No. ZRJY2024-QMPY43.

Institutional review board statement: The study has been approved by the Ethics Committee of the China-Japan Friendship Hospital, approval No. 2022-ky-221.

Informed consent statement: All participants enrolled in this study provided written informed consent prior to study initiation.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.

Corresponding author: Fan-Qiang Meng, Chief, Professor, Department of Gastrointestinal Surgery, China-Japan Friendship Hospital, No. 2 Yinghua Yuan East Street, Beijing 100029, China. mengfanqiang75@163.com

Received: December 5, 2025
Revised: January 9, 2026
Accepted: March 25, 2026
Published online: June 27, 2026
Processing time: 194 Days and 13.3 Hours

Abstract

BACKGROUND

Laparoscopic sleeve gastrectomy (SG) as an effective treatment for obesity and related metabolic diseases which still lacks consensus on gastric transection starting points.

AIM

To investigate reliable anatomical landmarks to enhance surgical precision and improve outcomes.

METHODS

This observational study enrolled 100 patients with obesity who underwent laparoscopic SG between May and October 2024. Intraoperatively, the distance between the prepyloric vein and the first branch of the right gastroepiploic vessels crossing the midline of the pyloric canal (AB distance) was precisely measured to standardize transection initiation site for SG (TIS-SG), with the latter branch defined as the optimal TIS-SG. The study analyzed clinical parameters potentially affecting the AB distance, including sex, and body mass index (BMI). Furthermore, preoperative and postoperative changes in blood glucose and blood pressure were compared to assess the metabolic improvements associated with SG.

RESULTS

The average AB distance was 4.65 ± 0.89 cm, with 4 patients exceeding the recommended maximum of 6 cm. No significant differences were found based on BMI, blood pressure, or fasting glucose levels (P > 0.05). Male patients had a significantly larger AB distance compared to females (4.98 ± 0.99 cm vs 4.53 ± 0.84 cm, P = 0.027). Additionally, fasting blood glucose levels on the third postoperative day showed a significant reduction compared to preoperative levels (P < 0.001).

CONCLUSION

The AB distance is a stable and reliable anatomical marker for defining TIS-SG in SG, independent of metabolic factors and BMI. SG leads to short-term metabolic improvements, including better blood glucose and blood pressure control.

Keywords: Metabolic improvement; Surgical precision; Obesity; Right gastroepiploic artery; Pre-pyloric vein; Transection initiation site; Laparoscopic sleeve gastrectomy

Core Tip: This study identifies the AB distance (between the pre-pyloric vein and right gastroepiploic artery branch) as a stable anatomical marker for defining the transection initiation site for sleeve gastrectomy (SG). Unaffected by metabolic factors or body mass index, it enhances surgical precision. SG also yields short-term metabolic benefits, notably reduced fasting blood glucose.