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Review
. 2021 Apr 2;10(7):1479.
doi: 10.3390/jcm10071479.

Parenchymal Sparing Resection: Options in Duodenal and Pancreatic Surgery

Ugo Marchese  1   2 , Stylianos Tzedakis  1   2 , Einas Abou Ali  2   3 , Olivier Turrini  4   5 , Jean-Robert Delpero  4   5 , Romain Coriat  2   3 , David Fuks  1   2
Affiliations
Review

Parenchymal Sparing Resection: Options in Duodenal and Pancreatic Surgery

Ugo Marchese et al. J Clin Med. .

Abstract

Parenchymal sparing duodenal and pancreatic resection are safe procedures in selected patients with the aim to reduce endocrine and exocrine long-term dysfunction. When the tumor is benign or borderline malignant, this appears to be a good option for the surgeon, associated with low rates of severe surgery-related early postoperative complications and low in-hospital mortality. This mini review offers comments, tips and tricks, and a review of literature concerning those different options with specific illustrations in order to clarify their indication.

Keywords: ampullectomy; central-pancreatectomy; duodenectomy; enucleation; long-term functional outcomes; pancreatectomy; pancreatic sparing surgery; pancreatic tumor; uncus resection.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Pancreas anatomy: vascularization and relationship between common bile duct and main pancreatic duct.
Figure 2
Figure 2
Laparoscopic enucleation for intraductal papillary mucinous neoplasms (IPMN). (A) Identification of the communicant branch duct; (B) Secured clip at the origin of the communicant branch duct; (C) intraoperative ultrasonographic control; (D) Section of the communicant branch duct.
Figure 3
Figure 3
Uncus resection: (A) Schema; (B) Surgical view.
Figure 4
Figure 4
Central pancreatectomy: (A) Schema; (B) Central pancreatectomy extended to the right for isthmic pancreatic tumor. AH: hepatic artery; VP: portal vein; VS: splenic vein; VMS: superior mesenteric vein; 1: Gastroduodenal artery; 2: Superior pancreaticoduodenal artery; 3: common bile duct; 4: Inferior pancreaticoduodenal vein.
Figure 5
Figure 5
Ampullectomy (surgical view).
Figure 6
Figure 6
Duodenal sparing resection: (A) Partial distal duodenectomy. (B) Total duodenectomy with ampullectomy.
Figure 7
Figure 7
Laparoscopic total duodenectomy. (A) Kocher maneuver; (B) Duodenopancreatic division; (C) Identification of periampullary area; (D) Section of the ampulla; (E) Ampullo-jejunostomy by minilap incision; (F) Vision at the end of the procedure.
See this image and copyright information in PMC

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