Duodenum-preserving Pancreatic Head Resection for Benign Pancreatic Head Lesion

Kim, Sun Whe; Lee, Kuhn Uk; Park, Yong Hyun

Abstract

Pancreatoduodenectomy has been a standard procedure for periampullary cancer. Even when the benign lesion is limited to the pancreatic head, the same procedure has been applied if the lesion should be removed surgically. The duodenum has a key role in the digestive physiologic function. However, removal of the pancreatic head while preserving the duodenum has been considered a very risky procedure because of duodenal ischemia. Since the vascular anatomy of the peripancreatic area was thoroughly examined and a meticulous dissection technique was developed, duodenum-preserving procedure has been tried by several surgeons with success. In this paper we report our experience of duodenum-preserving pancreatic head resection. To our knowledge this is the first report in Korea. The lesions were insulinoma and two serous cystadenomas located at the pancreatic head. Total removal of the pancreatic head was performed trying to preserve pancreaticoduodenal vascular arcade without a Kocher maneuver. The common bile duct was totally preserved in all cases and cholecystectomy with T-tube choledochostomy was performed in one case. The pancreatic duct was ligated just distal to the ampullary portion and the distal pancreas was anastomosed to the posterior wall of the stomach. Operation time was 7 hours 30 minutes in one and 5 hours and 30 minutes in two cases. Transfusion was not required at all. Pancreatic leakage was developed in one case and cured with conservative management. Any complication related to the preservation of the duodenum(leakage or obstruction) had not developed. The patients were discharged on postoperative 46 day(due to pancreatic leakage), 18 days and 11 days respectively. In conclusion, duodenum-preserving pancreatic head resection is recommended for benign pancreatic head lesions, such as benign cystic tumor and localized chronic inflammation.