Pancreatic Head Resection with Segmental Duodenectomy

ABSTRACT

PURPOSE: Duodenum-preserving resection of the head of the pancreas (DPRHP) requires meticulous dissection to preserve vascular circulation to the parapapillary area and has high risks for ischemia of these organs and associated complications. Pancreatic head resection with a segmental duodenectomy (PHRSD) is introduced to overcome technical difficulty and high risk. METHODS: A PHRSD was performed in 4 patients, one each with duodenal mucosa cancer, intraductal an papillary mucinous neoplasm of the pancreas, a villotubular adenoma of the papilla, and a serous cystadenoma of the pancreas. A bilateral subcostal incision was used for the laparotomy. By using Kocher's maneuver and dividing the adjacent ligament, we achieved full mobilization of the duodenum with the pancreas head, and confirmed a pathologic lesion. The superior pancreatiocoduodenal arteries were ligated and divided at the root with preservation of the gastroduodenal and the right gastroepiploic arteries. The anterior inferior pancreaticoduodenal artery was also preserved. The pancreatic head was resected using a 3- to 5-cm segmental duodenectomy at level 6 cm below the pyloric ring. After resection, reconstruction was performed using a pancreaticogastrostomy, duodenoduodenostomy, choledochoduodenostomy. RESULTS: No transfusions were required, and the mean operation time was 357 minutes. After this operation, no serious complications were developed. Minor pancreatic leakage developed in one case and was easily cured by conservative management. All patients were followed up without any clinical problems till now. CONCLUSION: A PHRSD can be recommended for the management of benign or low-grade malignant lesions of the pancreatic head and can also be used for the treatment of early cancer or polypoid lesions, which cannot be removed by using endoscopy, located in the duodenal second portion or the papilla.