The left gastroepiploic artery arises from the splenic artery at the splenic hilum and runs along the greater curvature of the stomach from left to right in the greater omentum, anastomosing with the right gastroepiploic artery (from the gastroduodenal) to form the arterial arcade of the greater curvature. It supplies the left portion of the greater curvature, the gastric fundus region, and the greater omentum.
The left gastroepiploic artery is divided during total gastrectomy, sleeve gastrectomy, and splenectomy. In laparoscopic Nissen fundoplication requiring gastric fundus mobilisation, the short gastric vessels and sometimes the left gastroepiploic are divided to allow the fundus to wrap freely around the distal oesophagus without tension. The omentum based on the right gastroepiploic artery is used as a pedicled flap for perineal, mediastinal, and chest wall reconstruction.
Sleeve or total gastrectomy requiring division of the short gastric and left gastroepiploic vessels leaves the gastric remnant dependent on the right gastroepiploic supply; compromise of this right-sided arc from tension or inadvertent injury causes fundal or sleeve ischaemia and risk of anastomotic leak.
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