Section 6.7: Mobilisation of the periphery of the mid-region mesenteric fold

The right mesocolon is detached from the posterior abdominal wall

By separating overlying mesentery, from underlying fascia

This is mesofascial separation on the right side

And it is key to detachment of an intact mesentery

The peritoneum is also reflected at the lateral aspect of the ascending colon

This must be divided as part of mesenteric detachment

Gradually, the right colon and mesocolon are fully detached

The process of mesofascial separation is continued under the mesentery at the hepatic flexure

The mesenteric component of the flexure converges on the second part of the duodenum which it overlies

The mesofascial interface is placed under continuous stretch

Thereby exaggerating the interface between mesentery and fascia

With further separation of mesentery from fascia

The second part of the duodenum, and mesoduodenum

Are also now detached

It is helpful to occasional return the intestine and mesentery

And reorientate the dissection

At this stage in the dissection the mesentery distal to the DJ flexure, is almost fully detached

From the underlying fascia and posterior abdominal wall

Next, the hepatocolic region of the reflection must be divided

To do this, the mesenteric domain is retracted left,

And the reflection comes under stretch

Enabling its identification and sharp dissection

Once the second part of the duodenum has been detached from underlying fascia

The mesoduodenum can be detached in the same  manner

The duodenum is retracted left, interface between mesentery and fascia exaggerated

Enabling sharp separation of mesentery from fascia

This process is  continued as far medially as possible, without entering or disrupting the mesentery