J Korean Surg Soc.  2009 Apr;76(4):262-265. 10.4174/jkss.2009.76.4.262.

Pancreas-Sparing Total Duodenectomy

• Lee SE
• Hwang DW
• Lim CS
• Jang JY
• Kim SW

• KMID: 1465066
• DOI: http://doi.org/10.4174/jkss.2009.76.4.262

Abstract

Pancreas-sparing total duodenectomy (PSTD), which allows preservation of the pancreas in its entirety is a promising procedure for benign or premalignant lesions at duodenum without invading the pancreas. We report two cases of tubular adenoma of Ampulla of Vater and a GIST of duodenum, which were resected by PSTD. The proximal duodenum was transected at 2 cm distal of pylorus and the distal end was cut in the distal portion of the Treitz ligament. The proximal jejunal limb was used for biliary-pancreatic duct systems reconstruction with end-to-side anastomosis and distal jejunum was anastomosed to duodenal bulb with an end-to-side anastomosis. Although a pancreatic fistula occurred in one patient, it was improved by conservative management. PSTD is a challenging surgical technique and requires excellent knowledge of anatomy. If performed for appropriate indications, PSTD is a useful alternative to formal pancreatoduodenecotmy and can be done safely with gastrointestinal function maintained.

Keyword

Pancreas; Duodenectomy

MeSH Terms

Adenoma
Ampulla of Vater
Duodenum
Extremities
Humans
Jejunum
Ligaments
Pancreas
Pancreatic Fistula
Pylorus

Figure

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  Fig. 1 (A) Operative field of case 1 after pancreas- sparing total duodenectomy. (B) An overview of the completed reconstruction with choledocho-jejunostomy, pancreaticojejunostomy and duodenojejunostomy of case 1 with the common bile duct indwelled rubber T-tube and pancreatic duct indwelled feeding tube. (C) Operative field after removal of specimen. (D) Operative field after completion of reconstruction.

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  Fig. 2 (A) Operative field of case 2 after pancreas-sparing total duodenectomy. (B) An overview of the completed reconstruction with biliary-pancreaticojejunostomy and duodenojejunostomy of case 2 with the pancreatic duct indwelled feeding tube. (C) Specimen of case 2.

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