Abdominal Injuries
Mansoor Khan, David Nott in 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).
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].
Related Knowledge Centers
- Abdominal Aorta
- Aorta
- Bleeding
- Pancreas
- Pancreaticoduodenectomy
- Surgery
- Vascular Surgery
- Venae Cavae
- Duodenum
- Retroperitoneal Space