Extended excision of the ampulla of Vater--a new operative technique for elderly patients

This report describes a 72-year-old female patient treated by extended excision of recurrent ampullary carcinoma. The procedure comprised pylorus-preserving resection of the descending segment of the duodenum, and excision of a large portion of the pancreatic head using an ultrasonic surgical dissector. Restoration of food transit, pancreatico-jejunal and choledocho-jejunal anastomosis by a Roux-en-Y reconstruction was readily accomplished. The operation, which has the advantage of being more radical and accurate than the standard excision of the ampulla of Vater, and less time-consuming and mutilating than the Whipple procedure, may be indicated in elderly patients with ampullary carcinoma.