New pancreas-preserving total duodenectomy technique

Area of Science:

• Surgical Oncology
• Gastroenterology
• Surgical Innovation

Background:

• Pancreas-preserving total duodenectomy (PPTD) is a surgical option for diffuse duodenal diseases not involving the pancreatic head, primarily familial adenomatous polyposis (FAP).
• Previous PPTD techniques have evolved, with ongoing efforts to refine the procedure for improved safety and efficacy.

Observation:

• A novel, simplified, and safer PPTD technique was applied to three patients with diverse conditions: intestinal amyloidosis, multiple endocrine neoplasia type 1 with Zollinger-Ellison syndrome, and FAP.
• The modified technique involves mucosectomy of the major papilla, sphincteropapillotomy, and direct anastomosis to the small intestine, preserving the main pancreatic duct (MPD).

Findings:

• The MPD was successfully stented and kept intact throughout the procedure, facilitating simpler biliopancreatic-ductal reconstruction.
• Alimentary tract reconstruction was achieved using either Billroth I or Billroth II methods.
• This represents the first report of PPTD preserving the entire MPD, enhancing the safety and simplicity of the reconstruction phase.

Implications:

• This refined PPTD technique offers a viable and potentially superior surgical solution for a range of duodenal pathologies.
• The preservation of the MPD simplifies reconstruction, potentially reducing complications and improving patient recovery.
• This approach expands the surgical armamentarium for managing complex duodenal diseases while safeguarding pancreatic function.