title: An investigation of the embryologic development of the fascia used as the basis for pancreaticoduodenal mobilization.
abstract: BACKGROUND
  The retropancreatic fusion fascia, or fascia of Treitz, is a critical anatomical landmark during retropancreatic mobilization of the pancreatic head and duodenum (the Kocher maneuver).
  
  
  METHODS
  Using semiserial sections from 24 human fetuses of 9-30 weeks gestation, we examined the development of this fascia.
  
  
  RESULTS
  Retroperitoneal fixation of the pancreas occurred at around 10 weeks. Up to 20 weeks, an apparent remnant of the mesoduodenum was attached to the now-distinct renal fascia. Lymphatic vessels and follicles congregated along the ventral aspect of the fusion plane during early development. In 20- to 30-week fetuses, the duodenum began to occupy a definite position and, at the same stage, a candidate for the fascia of Treitz was seen; it was separated from the thick renal fascia by loose connective tissue.
  
  
  CONCLUSIONS
  We hypothesize that mechanical stress during the development and growth of the duodenum causes the transformation of an indistinct remnant of the peritoneum into a distinct fascia. This mechanism is similar to that seen during the development of the renal fascia, in which the developing adrenal cortex and migrating kidney generate stress on a bundle of thin collagen fibers. Therefore, the fascia of Treitz is unlikely to be a simple remnant of the peritoneum. The fascia, if evident during surgery, should be attached to the pancreatic parenchymal side.
authors.affiliation: Department of Surgery, Faculty of Medicine, Medical School, Chonbuk National University, 634-18 Geumam-dong, Deokjin-gu, Jeonju, 561-712, Republic of Korea. chobh@chonbuk.ac.kr
authors.forename: Baik Hwan
authors.initials: BH
authors.lastname: Cho
authors.forename: Wataru
authors.initials: W
authors.lastname: Kimura
authors.forename: Chang Ho
authors.initials: CH
authors.lastname: Song
authors.forename: Mineko
authors.initials: M
authors.lastname: Fujimiya
authors.forename: Gen
authors.initials: G
authors.lastname: Murakami
mesh_terms: D004386:Duodenum / Q000196:embryology*; D005205:Fascia / Q000196:embryology*; D005865:Gestational Age; D006801:Humans; D007668:Kidney / Q000196:embryology; D010179:Pancreas / Q000196:embryology*; D010537:Peritoneum / Q000196:embryology