[Surgery of duodenal diverticula]

To test the results of treatment of juxtapapillary duodenal diverticula by direct attack and description of postoperative complications and subsequent surgical operations.

Retrospective analysis of case-records of ten patients with symptomatic duodenal diverticula in 1991-2002 in a regional surgical department. Clinical check-up examinations of all patients were made in November 2002.

The symptomatology of diverticula was diverticvulitis 2x, haemorrhage 1x, dyspeptic syndrome 4x, mechanical pressure of the diverticulum on the ductus choledochus 3x. Three parapapillary and 7 peripapillary diverticula were involved. The papilla led into the neck of the diverticulum 5x and into is lower part 2x. Performed types of operations: simple extraduodenal diverticulotomy 3x, partial excision of the diverticulum and anastomosis of its remnant with Roux loop 1x, transduodenal diverticulectomy 2x, excision of the diverticulum and reimplantation of the ductus choledochus and ductus pancreatitus into a separate incision of the duodenal wall 1x, excision of the diverticulumand reimplantation of the ductus choledochus and ductus pancraticus into the original site 1x, excision of the diverticulum, papillosphincteroplasty and reimplantation of the orifice of the ductus choledochus into the original site 1x, excision of the diverticulum from direct transverse duodenotomy 1x. One patient died from dehiscence of the duodenal suture, two had a transient duodenal fistula. Three patients were free from complicationed after operation, one suffered from dyspeptic syndrome, two had attacks of pancreatitis, two had after 4 years a papillosphincteroplasty and one a choledochoduodenostomy.

Only symptomatic diverticula are indicated for surgery. Parapapillary diverticula are resected extraduodenally, peripapillary diverticula are resected transduodenally with confirmation of the orifice of the papilla, possibly its reimplantation. Concurrent choledocholithiasis or stenosis of the papillare are frequent. If they are not treated a subsequent operation is necessary which eliminates the persisting complaints.