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Kocher maneuver
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Duodenum
The first of four portions of the duodenum, the bulb, begins at the pylorus and transitions into the second portion, the descending part. The horizontal portion begins at the inferior duodenal flexure and sweeps to the left. The ascending portion transitions into the jejunum at the duodenojejunal flexure (ligament of Treitz) The blood supply to the duodenum is provided by the gastroduodenal, pancreaticoduodenal and supraduodenal arteries, which originate from the celiac axis and the superior mesenteric artery.
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Indications
date of publication: 28.02.2012
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Incising the periduodenal peritoneum
The maneuver starts by incising the periduodenal peritoneum about 1 cm from the lateral duodenal margin. By gently pulling the bowel mediad the assistant puts traction on it. Lift the parietal peritoneum at the level of the mid-duodenum and incise it with scissors. Carry the dissection along the duodenum and posterior to it in the loose layer of the tela subserosa.
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Mobilizing the duodenum
Mobilize the duodenum as usual from its lateral aspect. This first exposes the inferior vena cava and allows palpation and visual inspection of the inferior aspect of the pancreatic head and the distal retroduodenal portion of the common bile duct. When it is necessary to reach the space posterior to the head of the pancreas, the dissection may be carried beyond the aorta.
Now the duodenum and pancreatic head can be grasped and moved.
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Complications
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Evidence
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Literature search
Literature search under: http://www.pubmed.com