Inframesocolic transduodenal approach to the distal biliary-pancreatic ductal system.

The usefulness of the inframesocolic transduodenal approach to the distal biliary system in patients in whom numerous previous procedures had been performed was evaluated. First, the feasibility of the technique was ascertained by anatomic study. Ten anatomic dissections were performed during routine postmortem examinations. This proved that the duodenum, ampulla of Vater, distal common duct, and head of the pancreas could be adequately exposed via the inframesocolic approach and that it was reasonable to use the procedure clinically. This approach has been used successfully in five cases. It was found that (1) the inframesocolic approach to the duodenum and distal biliary system is useful, particularly in those patients requiring second operations in the right upper quadrant; and (2) the approach allows ready access to the area through virgin territory and has distinct advantages in exposure, operative time, and information available.