Pancreas‐preserving total duodenectomy: a 10‐year experience

Penninga, Luit; Svendsen, Lars Bo

doi:10.1007/s00534-011-0382-9

Cited by 26 publications

(13 citation statements)

References 25 publications

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“…Relative to the standard Whipple procedure, the main advantage of this technique is that the resection of an organ that is not compromised by duodenal disease is avoided; indeed, in our case, CMV infection was restricted to the duodenum. In a young patient, the future occurrence of endocrine or exocrine dysfunctions resulting from partial pancreatectomy is unpredictable, and therefore, we believe that this technique was appropriate for this patient.…”

Section: Discussionmentioning

confidence: 82%

Pancreas‐preserving duodenectomy after living donor liver transplantation for invasive cytomegalovirus disease

Vincenzi

Fonseca

Chapchap

et al. 2017

Pediatric Transplantation

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CMV infection plays an important role in the postoperative course following solid organ transplantation. We present the case of an 11-year-old male patient who underwent LDLT due to severe hepatopulmonary syndrome and biliary cirrhosis. Four weeks after LDLT, he developed persistent GI bleeding and was subjected to repeated endoscopic treatment and radiological arterial embolization to stop the bleeding from duodenal ulcers. Diagnostic workup was negative for CMV disease. Because the bleeding persisted, surgical treatment was indicated, and a pancreas-preserving duodenectomy was performed. Immunohistochemical staining of the surgical specimen demonstrated diffuse endothelial infiltration by CMV. Despite ganciclovir treatment, the patient developed new erosions in the jejunal mucosa and melena; ganciclovir was discontinued, and foscarnet was started, resulting in clinical improvement and the cessation of bleeding. This case highlights the technical aspects of performing a complex upper GI resection in a patient recently subjected to LDLT, taking care to avoid injury to the previous liver graft anastomosis and restore GI continuity. Moreover, CMV tissue-invasive disease compartmentalized in the GI tract may be difficult to diagnose, as indicated by the negative results of antigenemia and PCR assays and endoscopic superficial mucosal biopsies.

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Section: Discussionmentioning

confidence: 82%

Pancreas‐preserving duodenectomy after living donor liver transplantation for invasive cytomegalovirus disease

Vincenzi

Fonseca

Chapchap

et al. 2017

Pediatric Transplantation

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“…In a recent report published by Penninga and Svendsen of 13 cases of PPTD [3], 10 patients had FAP syndrome, 2 had solitary tubulovillous adenomas, and 1 patient had multiple duodenal gastrointestinal stromal tumors (GIST), with 10 complications shared among 6 patients. Three patients developed anastomotic leaks, which were all successfully treated conservatively.…”

Section: Discussionmentioning

confidence: 98%

More with Less: Pancreas-Preserving Total Duodenectomy

et al. 2014

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A 49-year-old man was initially referred to the hepatobiliary and pancreatic surgery team following an incidental discovery of a duodenal ampullary polyp during esophagogastroduodenoscopy (EGD), which was carried out for worsening gastroesophageal reflux disease (GERD) symptoms.His past medical history included GERD, colon polyps on screening colonoscopy, and anxiety disorder. His surgical history included only tonsillectomy and no prior abdominal operations. His father had a history of colorectal cancer and his mother colon polyps. The patient did not smoke and drank two glasses of wine per day.Physical examination revealed an alert and oriented patient in no distress. His weight was stable at 80 kg. His abdominal examination revealed a soft and non-tender abdomen with no palpable masses. Laboratory findings were unremarkable. A computed axial tomography (CT) scan revealed an expansile filling defect in the second portion of duodenum without any evidence of duodenal adenopathy, peri-duodenal fat invasion, or distant disease ( Fig. 1). Re-endoscopy revealed a very large polypoid mass protruding from the ampulla of Vater in the second portion of the duodenum. Since the mass was nearly occlusive, it was not amenable to endoscopic resection.Biopsy samples confirmed fragments of adenomatous polyp. A small intestinal radiologic contrast study confirmed the presence of a large polypoid mass with a filling defect spanning over 6 cm.The patient was referred to the hepatobiliary and pancreatic surgery team for consideration for surgical resection. Given the size of the lesion and the presumption of benignity (based on biopsy and CT findings), the patient was taken to the operating room for what was planned to most likely be a pancreas-preserving total duodenectomy (PPTD). The case commenced with a cholecystectomy and opening of the cystic duct, which was cannulated with a guidewire to facilitate identification of the ampulla within the polyp. Visualization of the mass via a duodenotomy created at the level of the ampulla of Vater revealed it to be 10 cm with circumferential extension, confirming its near occlusive size within the second portion of the duodenum (Fig. 2). Thus, it was clearly not feasible to pursue a local resection as an ampullectomy. The duodenum was then meticulously freed proximally and distally, except at the ampulla, where the bile duct and pancreatic duct were transected sharply where they entered the duodenal wall. Next, the two ducts were slightly spatulated and sutured together to provide a common channel for a single anastomosis (Fig. 3). A two-layer anastomosis was created between the common ductal channel and the jejunal limb, and a Roux-en-Y reconstruction was fashioned to reestablish gastrointestinal continuity (Fig. 4). A JacksonPratt (JP) drain was placed in the surgical field beneath the biliary and pancreatic anastomosis.Formal pathologic analysis of the resected specimen revealed an adenomatous polyp with focal high-grade dysplasia (Fig. 5). Postoperatively, the patient made a full recov...

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“…PPD has several theoretical advantages over PD, including preservation of exocrine/endocrine function and avoiding pancreaticojejunostomy, thereby minimizing anastomotic leak and pancreatic fistula rates (69,70). In addition, the gastrointestinal tract can be maintained in continuity to facilitate endoscopic surveillance (24,43). Recent studies comparing PD with PPD in patients with premalignant/low-grade malignant (43) adenomas, GIST Muroni et al (39) 2012 CR GIST 1 0 (0) 0 (0) 6 Ravoire et al (46) 2012 CR GIST 1 0 (0) 1(100) 8 Masrur et al (37) 2012 CR Angiodysplasia 1 0 (0) 0 (0) lesions of the duodenum demonstrated that PPD was noninferior compared to PD in terms of morbidity, with superiority in terms of POPF, Intensive Care Unit stay, reoperation, mortality rates, blood loss, operative time and cost (45,71).…”

Section: Discussionmentioning

confidence: 99%

Non-Whipple Operations in the Management of Benign, Premalignant and Early Cancerous Duodenal Lesions

Papalampros

Moris

Petrou

et al. 2017

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Pancreas‐preserving total duodenectomy: a 10‐year experience

Abstract: Pancreas-preserving total duodenectomy appears to be a safe and valuable treatment option for patients with selected diseases of the duodenum.

Cited by 26 publications

References 25 publications

Pancreas‐preserving duodenectomy after living donor liver transplantation for invasive cytomegalovirus disease

Pancreas‐preserving duodenectomy after living donor liver transplantation for invasive cytomegalovirus disease

More with Less: Pancreas-Preserving Total Duodenectomy

Non-Whipple Operations in the Management of Benign, Premalignant and Early Cancerous Duodenal Lesions

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