Laparoscopy-assisted transduodenal papillectomy

Basically, patients with cancer of the major duodenal papilla should undergo pylorus-preserving pancreatoduodenectomy; however, patients with adenoma or cancer in adenoma do not require prophylactic lymph node dissection, so they are indicated for limited resection of the major duodenal papilla. Endoscopic snare resection (ESR) has developed as limited resection of the major duodenal papilla; however, the ESR technique is still restricted to certain centers, because its outcome depends on the technical skills of the endoscopist. Therefore, we attempted laparoscopy-assisted transduodenal papillectomy (LATDP).

Ports were placed at the umbilicus, upper abdomen, left hypochondrium and right flank. Initially, kocherization was performed, followed by laparoscopic cholecystectomy, and a C-tube was placed in the common bile duct through the cystic duct. Next, the port wound of the upper abdomen was extended 4 cm longitudinally, and only the descending part of the duodenum was extracted through this incision. The duodenum was opened opposite to the major duodenal papilla, and the major duodenal papilla was resected extracorporeally. After resection, the resection stumps of the bile duct and the pancreatic duct were sutured along with the duodenal mucosa. Lastly, the incision in the duodenum was stitched.

We performed LATDP in 2 patients with cancer in adenoma. These patients had uneventful postoperative courses, as had patients who had previously undergone transduodenal papillectomy (TDP) by the open method in our hospital.

LATDP is a feasible procedure that can be substituted for TDP and is less invasive after ESR.