Pancreas-sparing duodenectomy: classification, indication and procedures

Abstract

Background/aims: Recent advances in the surgical anatomy of the pancreatoduodenal region have permitted duodenum-preserving pancreatic head resection. However, pancreas-sparing duodenectomy (PSD) has not been systematically studied and various types of such procedures have been reported under the designation of PSD.

Methodology: PSD was performed in 6 patients with extensive duodenal lesions including trauma, mucosa-associated lymphoid tissue (MALT) lymphoma, corrosive necrosis, bleeding, leiomyosarcoma and congenital stenosis. Three patients had the whole papilla Vateri and half of the duodenum preserved and anastomosed to the jejunum. One patient had the duodenal button including the papilla of Vater transplanted to the jejunum. Another patient had the intraduodenal portion of the major papilla excised and the terminal portion of the bile and pancreatic ducts anastomosed to the jejunum.

Results: Two patients with moribund conditions died of the underlying disorders 2 weeks and 3 months after surgery, respectively, but without leakage or other surgery-associated complications. The other 4 patients survived the surgery without anastomotic insufficiency. Three survivors, who had complete preservation of the major and minor papillae along with the half portion of the duodenum, had normal morphology and function of the biliopancreatic system post-operatively. The fourth survivor, that with excision of the intrapancreatic portion of the major papilla, had regurgitation of contrast material into the bile and pancreatic ducts 2 months after surgery on active insufflation of the intestinal lumen, but remained asymptomatic. No abnormality in liver and pancreatic function was detected as of 7 months post-operatively.

Conclusions: PSD appears to be applicable in the clinical setting, although classification of the procedure seems mandatory in consideration of indications, techniques, and long-term consequences of biliopancreatic function.