Complete duodenum-preserving resection of the head of the pancreas with preservation of the biliary tract

Abstract

A complete resection of the head of the pancreas, with preservation of the duodenum and biliary tract was performed for 14 patients: 8 with chronic pancreatitis, 3 with mucin-producing cancer of the head of the pancreas, 2 with pancreas divisum, and 1 with cystadenoma of the head of the pancreas. With our technique, duodenal blood flow is maintained, and no pancreatic parenchyma is left on the duodenal side. For these patients, a pancreaticoduodenostomy without resection of the digestive tract was provided; however, for those in whom an anastomosis between the caudal side of the pancreas and the duodenum was too difficult, due to distance, a pancreaticojejunostomy, using a Roux-en-Y jejunal loop, was performed as an alternative method. The digestive tract was reconstructed by a pancreaticoduodenostomy in 8 patients and by a pancreaticojejunostomy in the remaining 6. The operation time for the former procedure was 5h, and for the latter, 5h and 40 min; the mean blood loss in both groups was similar, being 926 and 940 ml, respectively. The successful results in all cases indicate that maintenance of the duodenal blood flow is significantly related to complete resection of the head of the pancreas. Thus, it appears that the use of Kocher's maneuver should be avoided and that the preservation of the posterior superior pancreaticoduodenal artery is important.