Pancreatic head resection for noninflammatory benign lesions of the head of the pancreas

Introduction: Duodenum-preserving pancreatic head resection (DPPHR) has bee n safely performed in patients with chronic pancreatitis. The procedure has rarely been used to remove benign or borderline lesions of the head of the pancreas. Aims: To review our experience with 13 patients who underwent DPPHR and to review reports in the literature on the same subject. Methodology: From October 1991 to September 2000, 13 patients underwent DPP HR to resect endocrine pancreatic tumors (n = 4), beta cell hyperplasia (n = 1), pancreatic pseudocysts (n = 2), serous cystadenomas (n = 3), congenit al (n = 1) and choledochal (n = 1) cysts, and intraductal papillary mucinou s tumor (n = 1). The Kocher maneuver was performed in seven patients (group 1) and avoided in six (group 2). Type 1, 2, and 3 DPPHR were defined depen ding on the amount of pancreatic tissue left at the inner surface of the du odenum. Ten patients underwent evaluation that included an oral glucose tol erance test and exocrine pancreatic function test. Results: The mortality rate was zero; the complication rate was 69%. Patien ts in whom the Kocher maneuver was not performed (group 2) experienced fewe r complications, shorter stay on nasogastric tube and abdominal drain(s), a nd earlier water intake and discharge. Type of DPPHR did not influence the postoperative course, One patient died 3 months after surgery of unrelated disease. Twelve patients were alive and well 2 months to 8 years after surg ery. Conclusion: DPPHR is a low-risk procedure in patients with benign or border line noninflammatory lesions of the head of the pancreas in whom pylorus-pr eserving pancreaticoduodenectomy is otherwise indicated. Whenever possible, the Kocher maneuver should be avoided.