Surgery of the duodenum includes duodenotomy, duodenostomy, duodenal resection, pyloromyotomy, and partial anastomosis with stomach or jejunum. Good results from surgical procedures can be achieved if surgeons have good anatomical knowledge and if they practice good technique and conservative skeletonization. The duodenum is one of the most difficult areas to approach when operating, because the duodenum and pancreas are fixed; they share a common blood supply (superior and inferior pancreaticoduodenal arcades). The area of the opening of the common bile duct and pancreatic ducts is very complex.
Maneuvers for achieving exposure and mobilization of the duodenum are presented. A pancreaticoduodenectomy should be performed when malignant disease is found; with benign disease, a more conservative approach is the preferred treatment. The variations in the circular musculature must be kept in mind when performing pyloromyotomy. Step-by-step technique is given for repair of vascular compression of the duodenum.