Pancreas-preserving total duodenectomy without pancreato-enteric anastomosis

Pancreas-preserving total duodenectomy is a challenging surgical technique with organ preservation and has limited indications. We assessed the safety, feasibility and short-term functional outcome of PPTD without the need of pancreato-enteric anastomosis in our surgical technique.

During the two-year period from 2005 to 2007, three patients underwent pancreas-preserving total duodenectomy at our center. Two patients had diffuse adenomatous polyposis; another had previous transduodenal excision for polyp with recurrence. In all three patients pancreas-preserving total duodenectomy was performed without the pancreato-jejunal anastomosis and were analyzed prospectively. The surgical procedure and outcome is described.

Out of three patients who underwent pancreas-preserving total duodenectomy, one patient had pancreatitis postoperatively and recovered well with conservative line of management. The other two patients had an uneventful postoperative course. All the patients were closely followed up and were symptom free, in a good condition with good functional status.

To the best of our knowledge this is the first series of pancreas-preserving total duodenectomy without pancreato-enteric anastomosis ever reported. Although the indication for pancreas-preserving total duodenectomy is limited, it can be performed safely with good surgical expertise and knowledge of pancreato-duodenal anatomy. It can be beneficial in elderly patients with concomitant heart disease and associated risk factors. Although it is technically demanding requiring high surgical skills, it excludes the need of pancreas resection with maintenance of gastrointestinal function and the procedure can be performed safely and in less time. But the procedure should be contraindicated in the presence of malignancy and the operated patient should be under long-term surveillance.