Pancreas-sparing duodenectomy: Classification, indication and procedures

BACKGROUND/AIMS: Recent advances in the surgical anatomy of the pancreatodu odenal region have permitted duodenum-preserving pancreatic head resection. However, pancreas-sparing duodenectomy (PSD) has not been systematically s tudied and various types of such procedures have been reported under the de signation of PSD. METHODOLOGY: PSD was performed in 6 patients with extensive duodenal lesion s including trauma, mucosa-associated lymphoid tissue (MALT) lymphoma, corr osive necrosis, bleeding, leiomyosarcoma and congenital stenosis. Three pat ients had the whole papilla Vateri and half of the duodenum preserved and a nastomosed to the jejunum. One patient had the duodenal button including th e papilla of Vater transplanted to the jejunum. Another patient had the int raduodenal portion of the major papilla excised and the terminal portion of the bile and pancreatic ducts anastomosed to the jejunum. RESULTS: Two patients with moribund conditions died of the underlying disor ders 2 weeks and 3 months after surgery, respectively, but without leakage or other surgery-associated complications. The other 4 patients survived th e surgery without anastomotic insufficiency. Three survivors, who had compl ete preservation of the major and minor papillae along with the half portio n of the duodenum, had normal morphology and function of the biliopancreati c system post-operatively. The fourth survivor, that with excision of the i ntrapancreatic portion of the major papilla, had regurgitation of contrast material into the bile and pancreatic ducts 2 months after surgery on activ e insufflation of the intestinal lumen, but remained asymptomatic. No abnor mality in liver and pancreatic function was detected as of 7 months post-op eratively. CONCLUSIONS: PSD appears to be applicable in the clinical setting, although classification of the procedure seems mandatory in consideration of indica tions, techniques, and long-term consequences of biliopancreatic function.