What maneuver is used to expose the posterior wall of the stomach during an open laparotomy?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: March 11, 2026 • View editorial policy

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question

Kocher Maneuver

The maneuver used to expose the posterior wall of the stomach during open laparotomy is the Kocher maneuver, which involves mobilizing the duodenum by incising the lateral peritoneal reflection and reflecting the duodenum and pancreatic head medially to access the posterior gastric wall and retroperitoneum.

Technique and Application

The Kocher maneuver is a fundamental surgical technique that provides access to structures posterior to the stomach and duodenum. The procedure involves:

  • Incising the lateral peritoneal attachments of the duodenum along the white line of Toldt
  • Blunt dissection to mobilize the duodenum and pancreatic head medially
  • Reflection of the second and third portions of the duodenum toward the midline
  • This exposes the posterior wall of the stomach, pancreas, inferior vena cava, and aorta

Clinical Context in Gastric Surgery

During gastric operations, examining the posterior gastric wall is essential for:

  • Assessing tumor invasion in gastric cancer cases 1
  • Evaluating the bursa omentalis (lesser sac) for disease involvement
  • Determining the need for bursectomy when the posterior gastric wall serosa is infiltrated by tumor 1, 2

The Italian guidelines for gastric cancer specifically note that when the posterior gastric wall serosa is infiltrated, removal of the inner peritoneal surface of the bursa omentalis may be performed 1. However, bursectomy should be avoided in T1/T2 tumors to prevent injury to the pancreas and adjacent vessels 2.

Alternative Access Methods

While the Kocher maneuver is the standard approach for posterior gastric wall examination, other techniques may be employed depending on the surgical context:

  • Division of the gastrocolic ligament provides access to the lesser sac from an anterior approach
  • Hanging maneuver of the stomach (primarily used in laparoscopic procedures) involves encircling the stomach with tape and retracting it to expose posterior structures 3

Important Surgical Considerations

When performing the Kocher maneuver:

  • Avoid excessive traction that could injure the superior mesenteric vessels
  • Identify the inferior vena cava to prevent inadvertent injury
  • Assess for anatomic variations in vascular anatomy before proceeding
  • The maneuver is reversible and the duodenum returns to its normal position after the procedure

This technique remains a cornerstone of upper abdominal surgery and is essential knowledge for any surgeon performing gastric or pancreatic operations.

References

Related Questions

A 68-year-old white male, 21 days post total hip arthroplasty, has itching at the clean, dry surgical site without drainage; what measures can be taken to resolve or minimize the itching?
In a 79-year-old patient receiving enteral tube feeding who presents with diarrhea, which stool test should be ordered first?
In a 55‑year‑old man with a recent electrocardiogram showing sinus rhythm, a QS complex in V1, poor R‑wave progression in V2, left‑atrial enlargement, and a prolonged QT interval, what is the most likely diagnosis and appropriate treatment?
How do I convert an infusion rate of 60 cc per hour to drops per minute using a microdrip set?
What is the appropriate evaluation and management for an 82‑year‑old male presenting with lower abdominal pain and a burning sensation on urination?
Is atorvastatin safe during pregnancy in a patient with a prior ischemic stroke?
How should acute otitis media and acute otitis externa be managed in children and adults, including first‑line therapy, alternative antibiotics, and symptomatic relief?
What maneuver is used to examine the posterior wall of the stomach?
How should malnutrition be treated in adults?
What cognitive‑behavioral therapy (CBT) techniques can be used to manage fear and anxiety after learning of the death of a close loved one?
Does Depo‑Provera (medroxyprogesterone acetate) cause headaches?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.