Bile duct preserving pancreatic head resection (BDPPHR): Can we conclusively define the extent of head resection in surgery for chronic pancreatitis?

Abstract

The role of surgical management for chronic pancreatitis in providing pain relief and improving quality of life is significant. Surgical techniques involving pancreatic head resection scored more over the drainage procedures. Among the resection procedures, Frey's procedure received widespread acceptance. However, the exact extent of pancreatic head resection to be performed and the limits of the resection are still debatable. The present report of bile duct preserving pancreatic head resection (BDPPHR) describes an innovative approach to the pancreatic head and conclusively defines the extent of head resection. The simplicity, feasibility and easy reproducibility of the BDPPHR is also reiterated.

Keywords: Chronic pancreatitis; Pancreatic head resection; Posterior pancreatic capsule; Surgery.

Fig. 1

Image showing technique of blunt dissection through anterior surface of the pancreatic parenchyma with the attempt to define posterior pancreatic capsule in head of the pancreas (marked with transparent arrow). Entire pancreatic duct in the body and tail region of pancreas was exposed (pointed with Black arrow). The Left hand of operating surgeon behind the kocherised duodenum and head of pancreas is guiding the procedure. Exposed posterior pancreatic capsule is marked with blue arrow.

Fig. 2

Line diagram showing perpendicular plane of transection in BDPPHR as compared with Frey’s procedure.

Fig. 3

Image showing completed bile-duct preserving pancreatic head resection (BDPPHR) technique. This image also highlights the possibility of leaving significant amount of pancreatic tissue by performing pancreatic head resection when posterior wall of pancreatic duct is considered as the limit of resection.

Fig. 4

Line diagram showing the view of pancreas from inferior aspect following BDPPHR with posterior pancreatic capsule as the posterior limit of pancreatic head resection.

Fig. 5

CECT abdomen image of postoperative patient – six months following bile duct preserving pancreatic head resection with posterior pancreatic capsule as the limit of resection (pointed with red arrow).