AMPULLECTOMY FOR ADENOMA OF THE PAPILLA AND AMPULLA OF VATER

Introduction: The frequency of malignant adenomas of the papilla figur es between 15 and 30%. Villous adenoma is considered to be a premalign ant lesion. Treatment: Resection of the papilla is indicated in large tubular and small tubulovillous adenoma. Ampullectomy, however, is man datory in villous adenoma with severe dysplasia and large villous or t ubulovillous adenoma. If villous adenoma with a low-risk pT 1 N0 M0 G1 /2-cancer is treated by ampullectomy, local lymph dissection should al so be performed. Ampullectomy includes extirpation of the ampulla of V ater and reinsertion of the common bile duct and the pancreatic main d uct into the duodenal wall. Results: Hospital mortality after ampullec tomy is less than 0.4%, and surgical morbidity, e.g., cholangitis, bel ow 10%.