[Pylorus-preserving pancreatic head resection. Video article]

Area of Science:

• Gastroenterology and Surgical Oncology

Background:

• The pylorus preserving pancreatoduodenectomy (PPPD) is a key surgical procedure for various upper gastrointestinal malignancies.
• This technique is also utilized for treating chronic pancreatitis, offering a therapeutic option beyond cancer treatment.

Purpose of the Study:

• To detail the standardized surgical steps of the PPPD procedure.
• To highlight the importance of complication management in PPPD, given its non-negligible complication rates.
• To showcase a PPPD case for duodenal polyps in familial adenomatous polyposis, illustrating its application beyond primary oncologic indications.

Main Methods:

• The procedure involves distinct exploration, resection, and reconstruction phases.
• Systematic lymphadenectomy of the hepatoduodenal ligament is crucial for malignant tumors.
• The accompanying video demonstrates PPPD for duodenal polyps post-endoscopic ablation failure.

Main Results:

• The perioperative mortality rate for PPPD typically ranges from 3% to 5%.
• Common complications include delayed gastric emptying and pancreatic fistulas, necessitating careful management.
• The presented case illustrates successful application in a non-malignant, complex scenario.

Conclusions:

• PPPD is a standardized yet complex surgical procedure with established indications and a defined risk profile.
• Effective management of potential complications is integral to successful patient outcomes.
• The adaptability of PPPD is demonstrated by its use in complex benign conditions, as shown in the video case study.