The Kocher manoeuvre is a surgical procedure to expose structures in the retroperitoneum behind the duodenum and pancreas. In vascular surgery, it is described as a method to expose the abdominal aorta. It usually has been in contrast to midline laparotomy and right retroperitoneal space dissection. These two procedures have been used for diverse cases, but have approximately equivalent outcomes. The Kocher manoeuvre may also refer to a procedure used to reduce anterior shoulder dislocations by externally rotating the shoulder, before adducting and internally rotating it.

Uses

Technique

The Kocher manoeuvre involves the following steps:

History

In 1895, Jourdain first talked about moving the duodenum in the body. Theodor Kocher, after whom the manoeuvre is named, wrote a detailed explanation of this in 1903. He explained that during early development, the duodenum is freely hanging in the belly. In children, it's even more flexible, but as they grow, it sticks to the back of the belly and is covered in a layer of peritoneum. Kocher figured out that by loosening it, the duodenum could be moved like it was in the early stages of development. Kocher also knew that the duodenum and pancreas are initially hanging freely in the belly, connected by a mesentery. The Kocher maneuver brings these organs back to their original position in the belly. Since Kocher's time, we've learned more about how the duodenum and pancreas develop and settle into their final position in the body. This study will briefly explain these processes, outline the surgical anatomy of the area, and discuss some clinical issues related to embryology and anatomy.