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Abdominal Injuries
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Duodenal injuries are relatively rare, but inappropriate management may result in high morbidity and mortality. The Kocher manoeuvre should be performed for duodenal exploration (Figure 10.18). To achieve a complete duodenal examination (check for a through-and-through injury), digital dissection pushing up the peritoneal attachments from the duodenal wall is performed up to the head of the pancreas. The Ligament of Treitz must also be dissected (undertaken as described previously by a full right medial visceral rotation).
The Abdomen
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
After mobilizing the right hemicolon from the hepatic flexure to the caecum, and performing a Kocher's manoeuvre, the small bowel mesentery is mobilized by sharply incising its retroperitoneal attachments from the right lower quadrant, to the ligament of Treitz, by progressively lifting up the caecum. The entire ascending colon and caecum are then reflected superiorly towards the left upper quadrant of the abdomen. A Kocher manoeuvre is performed as well. This will expose the right retroperitoneum (Figure 9.1.4). The small bowel mobilization is undertaken by sharply incising its retroperitoneal attachments from the right lower quadrant to the ligament of Treitz. The entire ascending colon and the caecum are then reflected superiorly towards the left upper quadrant of the abdomen.
A chronicle of the pancreatoduodenectomy technique development – from the surgeon’s hand to the robotic arm
Published in Acta Chirurgica Belgica, 2023
Marek Olakowski, Beata Jabłońska, Sławomir Mrowiec
However, minimally invasive PD is not only about the benefits and there are also some disadvantages, such as long learning curve accompanied by increased postoperative morbidity and mortality, difficulties with exposure during surgery of certain anatomical structures - pancreatic hook (Kocher manoeuvre) and their identification (anatomical variants of the hepatic artery) and also gastrointestinal reconstruction (pancreaticoduodenal anastomosis). Other important problems that can be encountered during minimally invasive procedures are uncontrolled hemorrhages both intraoperatively, requiring conversion to laparotomy, and postoperatively. These occur due to the use of vascular staplers and high energy devices during larger diameter vessel closure, which are routinely ligated during open surgery [44].
Cephalic pancreaticoduodenectomy with preservation of a right coronary artery bypass graft using the right gastro-epiploic artery: a case report
Published in Acta Chirurgica Belgica, 2019
K. Homsy, J.-L. Paquay, H. Farghadani
The procedure began by an abdominal exploration through a bi-subcostal laparotomy confirming a pulsating right gastro-epiploic artery. The artery was found running anterior to the left hepatic lobe, through a diaphragmatic hiatus reaching the pericardial space. A clamping test of the gastroduodenal and right gastro-epiploic artery confirmed myocardial tolerance to short-term ischemia. After a Kocher manoeuver in order to evaluate the resectability of the tumor, priority was given to isolating the right gastro-epiploic artery. The common hepatic artery as well as the gastroduodenal artery was isolated. The gastro-duodenal artery was clamped and ligated at its origin allowing the section of the vessel. The right gastro-epiploic artery was removed from its origin and an end-to-end re-implantation to the origin of the gastroduodenal artery was made using an 8/0 polypropylene monofilament running suture. With cardiac revascularization restored, a regular cephalic pancreaticoduodenectomy was performed with no complications. Extended lymphadenectomy around the hepatic pedicle, and interaortocaval region was made. Digestive reconstruction was performed by pancreaticojejunostomy, hepaticojejunostomy and gastrojejunostomy using a ‘Roux-en-Y’ anastomosis.
Gastric conduit obstruction due to gastroduodenal compression: a new complication post-Ivor–Lewis oesophagectomy
Published in Acta Chirurgica Belgica, 2018
Victoria A. Perkins, Samuel McFerran, Ali Kordzadeh, Elias Sdralis, Bruno Lorenzi, Alexandros Charalabopoulos
Two years previously, he underwent a curative laparoscopic-assisted Ivor–Lewis oesophagogastrectomy for a T1b distal oesophageal adenocarcinoma arising on a background of Barrett’s oesophagus, which had been under surveillance. During that procedure and as we routinely apply to all our oesophagogastrectomies regardless of the approach, neither a Kocher manoeuver nor any surgical technique to reduce diaphragmatic herniation like diaphragmatic crura approximation or gastropexy, was performed. Post-operatively, he developed a small, contained and subclinical anastomotic leak, which was managed conservatively. His recovery was otherwise uneventful. Since the oesophagectomy, he had been admitted to hospital on at least four additional occasions with worsening vomiting and/or features of aspiration. He also experienced episodes of early satiety and reflux that prompted him to contact the clinical team for further review.