DUODENUM-PRESERVING PANCREATODUODENOSTOMY - A NEW TECHNIQUE FOR COMPLETE EXCISION OF THE HEAD OF THE PANCREAS WITH PRESERVATION OF BILIARY AND ALIMENTARY INTEGRITY

A new technique for complete excision of the head of the pancreas with preservation of the biliary and digestive tract is described. A serie s of 11 patients with chronic pancreatitis, pancreatic divisum, or a l ow-grade malignancy (mucus-producing pancreatic cancer) who underwent the procedure is reported. Previously described techniques for ''duode num-preserving pancreatic resection'' differ from ours in two ways. Fi rst, other techniques accomplished only a ''partial resection'', retai ning a rim of pancreas along the duodenum, and second, the pancreatoen teric anastomosis utilized a Roux-en-Y jejunal loop. Our procedure per mits complete resection of the pancreatic head, which in turn permits a pancreatoduodenal anastomosis. This preserves the normal physiology of pancreatic digestive function. To assure an adequate blood supply t o the duodenum, retroperitoneal vessels must be preserved by avoiding Kocher's maneuver, and the posterior superior pancreatoduodenal artery must also be preserved. This operation was successfully performed in 8 consecutive patients when these provisos were adhered to.