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Laparoscopic ampullectomy for an ampullarian adenoma
Frédéric Borie1, Alban Zarzavadjian Le Bian
1Service de Chirurgie Digestive, Hépato-biliaire et pancréatique, CHU Carémeau, Nîmes, France.
Surgical Endoscopy
|July 10, 2013
Summary
Ampullary lesions, though rare, have high malignant potential. Laparoscopic ampullectomy offers a safe alternative to traditional surgery for select cases, demonstrating good outcomes.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Ampullary lesions are rare (0.1-0.2%) with a high (90%) risk of malignancy.
- Historically, duodenopancreatectomy was the primary treatment regardless of tumor stage.
- Advancements in endoscopic techniques allow for endoscopic removal of adenomas and early-stage adenocarcinomas.
Observation:
- A 52-year-old patient presented with abdominal pain, leading to the discovery of an ampulloma.
- Endoscopic ultrasound with biopsy confirmed a 15-mm adenoma with moderate-grade dysplasia.
- Thoracoabdominal CT scan showed no other abnormalities.
Findings:
- Surgical ampullectomy was performed laparoscopically.
- Histopathology revealed complete R0 resection with a 5-mm margin of an adenoma with focal high-grade dysplasia.
- The patient experienced an unremarkable 3-year follow-up with no complications.
Implications:
- Laparoscopic ampullectomy is a viable and safe alternative to more extensive surgery for specific ampullary adenomas.
- This minimally invasive approach can be considered when endoscopic removal is not feasible.
- Successful outcomes suggest potential for broader adoption in select patient populations.
