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Indications and outcomes of duodenum-preserving resection of the pancreatic head in children

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Abstract

Aim of study

Duodenum-preserving resection of the pancreatic head (DPRPH) with Roux-en-Y pancreatojejunostomy is a procedure used to remove focal pathological lesions of the pancreatic head. Although predominantly used in adult patients, it is both safe and effective in children. The aim of this study was to review our experience with this procedure, with focus on its indications, complications and long-term outcomes.

Methods

A retrospective analysis of pediatric patients who underwent DPRPH between 1994 and 2015 was performed. Patient files were reviewed for demographic, diagnostic, operative and histological details, postoperative complications. Patients were contacted telephonically and sent questionnaires to determine long-term outcomes.

Results

The study cohort consists of 21 patients, 14 girls and 7 boys, with an average age of 11.72 years (range 3 months to 18.6 years), who underwent DPRPH with end-to-end anastomosis of the jejunum to the pancreatic body (Roux-en-Y anastomosis). In four cases the head and also part of the body of the pancreas was resected. In the remaining 17 cases, only the head of the pancreas was resected. Indications for DPRPH were solid pseudopapillary tumor of the pancreas (n = 10), trauma (n = 8), pancreas divisum (n = 1), focal congenital hyperinsulinism (n = 1) and pancreatic cyst (n = 1). The length of follow-up ranged from 1 to 22 years (average 9.66). One patient developed a biliary fistula, which closed spontaneously within 2 weeks after stent insertion. A recurrence of abdominal pain was reported in two patients, occurring at 7 months after the operation in one patient and at 1 year in the other. Pancreatic endocrine insufficiency did not occur in any of the 21 patients. Seven patients currently require a low fat diet, five of which need pancreatic enzyme supplementation. An additional two patients need enzyme supplementation without dietary restriction.

Conclusion

DPRPH is a safe and effective procedure for the treatment of large focal pathological lesions of the pancreatic head in children. As a less invasive procedure than pancreatoduodenectomy, it is more appropriate for the developing child.

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Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, Institute of Postgraduate Medicine, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic

    Jiri Snajdauf

  2. Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic

    Jiri Snajdauf, Michal Rygl, Ondrej Petru, Jiri Nahlovsky, Barbora Frybova & Marianna Durilova

  3. Department of Anesthesiology and Intensive Care Medicine, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic

    Vladimir Mixa

  4. Department of Internal Medicine, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic

    Radan Keil

  5. Department of Radiology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic

    Martin Kyncl

  6. Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic

    Roman Kodet

  7. Department of Surgery, University Hospital Kralovske Vinohrady, Prague, Czech Republic

    Adam Whitley

  8. Department of Anatomy, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic

    Adam Whitley

Authors
  1. Jiri Snajdauf
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  2. Michal Rygl
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  4. Jiri Nahlovsky
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Correspondence to Jiri Nahlovsky.

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All authors declare that they have no conflicts of interest.

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All procedures performed were in accordance with the ethical standards of the institutions involved, in accordance with national ethical standards and with the 1964 Helsinki declaration.

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Informed consent was obtained from all individual participants included in the study.

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Snajdauf, J., Rygl, M., Petru, O. et al. Indications and outcomes of duodenum-preserving resection of the pancreatic head in children. Pediatr Surg Int 35, 449–455 (2019). https://doi.org/10.1007/s00383-018-4410-6

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