Transduodenal Ampullography: Extending Surgical Safety Near Pancreaticobiliary Junction

Area of Science:

• Gastroenterology
• Surgical Innovation
• Anatomical Studies

Background:

• The pancreaticobiliary junction (PBJ) is anatomically complex, making surgery near it challenging.
• Inadvertent injury to the pancreatic or bile ducts during PBJ surgery increases patient morbidity.
• Improper closure of the distal biliary stump after choledochal cyst (CDC) excision can lead to pancreatic leaks or collections.

Purpose of the Study:

• To introduce and describe a novel technique, transduodenal ampullography (TAG), for securing the distal biliary stump during CDC excision.
• To demonstrate the utility of TAG in managing challenging surgical situations near the PBJ.
• To evaluate the safety and feasibility of TAG in preventing complications like pancreatic leaks.

Main Methods:

• A case report detailing the application of TAG in a patient with type I CDC undergoing excision.
• The technique involved duodenotomy, cannulation of the ampulla, and dye injection to identify the retracted distal bile duct stump.
• The identified stump was secured with sutures, and a pancreatic stent was placed.

Main Results:

• TAG successfully enabled the secure closure of an accidentally transected and retracted distal bile duct stump.
• The patient experienced an uneventful postoperative course with no pancreatic leak or intra-abdominal collections.
• The described method facilitated the completion of the CDC excision and subsequent Roux-en-Y bilioenteric anastomosis.

Conclusions:

• Transduodenal ampullography (TAG) is a safe, simple, and feasible technique for securing the intrapancreatic distal bile duct.
• TAG is particularly useful in special surgical situations near the pancreaticobiliary junction.
• This technique can extend surgical safety margins in complex PBJ procedures.