Morpho-topographic features of the course of gastric wall muscle fibers in the esophagogastric junction during sleeve gastrectomy

Sleeve gastrectomy, also known as vertical gastrectomy, is one of the most common and popular bariatric surgeries in the world. This surgery has become particularly popular in recent decades due to its effectiveness in reducing weight and improving associated metabolic disorders. However, despite the high effectiveness of this surgery, stapling line failure remains one of the most serious complications that can lead to severe consequences such as peritonitis, sepsis, and prolonged hospital stay. The study of the morphotopographic features of the course of the muscle fibers of the gastric wall in the area of the esophagogastric junction is relevant for understanding the mechanisms of suture failure and developing preventive measures. The aim of the study was to evaluate the morphotopographic features of the course of the gastric wall muscle fibers in the esophagogastric junction during sleeve gastrectomy. A comprehensive study of the anatomical and functional characteristics of the gastric muscle layer in the area of the esophagogastric junction was carried out. A significant change in the architectonics of the muscular layer is noted in the esophagogastric junction zone. The circular muscles predominate here, which indicates the functional adaptation of this area to the regulation of food passage. Taking into account the transition from the anatomical zone of the esophagus to the stomach, the appearance of new muscle layers was revealed due to the physiological specificity of the hollow organ. By sequential dissection of the muscle layers, using the methods of histological analysis and macroscopic morphometry, specific features of muscle fibers that affect the formation of the staple line were revealed, namely, a mostly parallel course of fibers in the area of the angle of His and crossed distally from it, the thickness of the muscle layer at the level of the angle of His prevails over the distal level. Thus, the results obtained are important for improving the surgical technique of sleeve gastrectomy, in particular, the choice of the optimal location and direction of the suture – the formation of a continuous “layer” of crossed muscle fibers of the gastric body, the transition of longitudinal esophageal muscle fibers to the bottom and the large curvature of the stomach, which, together with circular fibers, acquire a perpendicular orientation to the level of staple suture application.