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[Ampullectomy in benign lesion: indications and results]
1Centre de chirurgie digestive de l'hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
Annales De Chirurgie
|March 31, 2004
Summary
Ampullectomy is a safe and effective treatment for presumed benign ampullary and papillary lesions, with accurate frozen section analysis guiding surgical decisions and minimizing morbidity. This approach offers an alternative to pancreaticoduodenectomy (PD).
Area of Science:
- Gastroenterology
- Surgical Oncology
- Pathology
Background:
- Surgical resection is the standard for ampullary and papillary tumors.
- The choice between pancreaticoduodenectomy (PD) and ampullectomy for benign lesions is debated due to morbidity concerns.
- Ampullectomy offers functional preservation compared to PD.
Purpose of the Study:
- To report the experience with ampullectomies for presumed benign ampullary and papillary lesions.
- To analyze the indications and outcomes of ampullectomies.
- To review both the current series and published literature on ampullectomy.
Main Methods:
- Eight ampullectomies were performed for presumed benign lesions since 1997.
- Intra-operative frozen section analysis was utilized.
- Morphologic criteria and pre-operative endoscopic biopsies informed the decision-making process.
Main Results:
- No post-operative mortality was observed.
- Post-operative morbidity included one bilio-enteric fistula and four cases of acute pancreatitis, all managed conservatively.
- Final pathology revealed various benign and malignant lesions, including adenomas in familial adenomatous polyposis (FAP) patients. Some lesions were treated endoscopically during follow-up.
Conclusions:
- Ampullectomy, when combined with accurate intra-operative frozen section, is a suitable procedure for presumed benign lesions of the papilla and ampulla.
- This approach provides a viable alternative to more extensive resections like PD for selected cases.