Duodenal exposure

ANATOMY
DJ junction marked by ligament of Trietz (from right crus of diaphragm)
Blood supply of 1st part variable: usually from supraduodenal artery from gastroduodenal from common hepatic
Rest by arcades from four arteries: ant sup pancreaticoduodenal from gastroduodenal. inferior arteries from SMA. Ligate only one of the two arcades.

Meissner’s plexus in submucosa, Auerbachs plexus in muscularis externa

IMV located to the left of paraduodenal fossa

PROCEDURE
Kocher Manouvre
Cattell manouvre: incision through transverse mesocolon or gastrocolic omentum or reflection of the right half of the colon to expose the third part of the duodenum proximal to SMA

Accessory pancreatic duct of Santorini passes under gastroduodenal artery thus to avoid transecting it ligate artery away from anterior medial duodenal wall (Water under the bridge as with ureter and uterine artery)

CBD is mostly located to the right of the gastroduodenal artery at the posterior wall of the 1st part of duodenum