Our Experience With Transduodenal Surgical Ampullectomy

Abstract

Tumors of the ampulla of Vater are uncommon lesions accounting for only 0.5% of the gastrointestinal tumors. A total of three techniques for ampullary tumors (AT) exist: endoscopic papillectomy (EP), surgical transduodenal ampullectomy (TDA), and partial pancreatoduodenectomy (PD). Scarce articles report the outcomes of TDA. Two Arabic men presented to the hospital with epigastric pain and were subsequently diagnosed with AT. The TDA was performed a few days after the diagnosis. The first patient underwent a partial gastrectomy on the eleventh postoperative day. The second patient underwent endoscopic pyloric re-opening on the eleventh postoperative day to relieve gastric obstruction. Both patients started tolerating food and were discharged home. Further randomized controlled studies assessing long-term complications, efficacy, and efficiency of TDA are now warranted.

Keywords: ampulla; endoscopic papillectomy; transduodenal ampullectomy; tumors of the ampulla; whipple procedure.

Figure 1. Abdominal CT scan with oral contrast showing biliary ducts dilation (arrows)

Figure 2. Intra-operative image of surgical transduodunal ampullectomy showing the ampulloma (arrow)

Figure 3. Ampullary adenoma with low-grade dysplasia

Figure 4. Ampullary tumor visualized on ERCP

ERCP - endoscopic retrograde cholangiopancreatography

Figure 5. Ampullary adenocarcinoma of intermediate grade

Figure 6. Abdominal CT scan showing distended stomach (arrow) 10 days post-operatively