Published online Apr 23, 2009.
https://doi.org/10.4174/jkss.2009.76.4.262
Pancreas-Sparing Total Duodenectomy
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.
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.
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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