Laparoscopic duodenum-preserving total pancreatic head resection for benign and low-grade malignant tumors close to the accessory papilla (a case series).

BACKGROUND

To describe methods for complete resection of pancreatic tissue in the vicinity of the accessory papilla in duodenum-preserving total pancreatic head resection (DPPHRt).

METHODS

Thirteen consecutive patients (four males, nine females; mean age: 48 ± 20.80 y) with pancreatic head benign or low-grade malignant tumors (mean maximum tumor diameter: 4.88 ± 1.40 cm) underwent laparoscopic DPPHRt. Surgical approach for pancreatic tissue resection in accessory papilla region involved partial preservation (excision group, n = 6) or complete resection (en bloc group, n = 7). Depending on the extent of duodenal wall injury, direct suture repair or jejunal loop seromuscular patching was performed.

RESULTS

All patients underwent laparoscopic DPPHRt successfully. Mean operative time was 6.58 ± 0.38 h in excision group (case 2 excluded) and 5.89 ± 0.82 h in en bloc group (P > .05), while the mean intraoperative bleeding volume between two groups were 54 ± 23.29 mL and 60.71 ± 21 mL (P > .05), respectively. Mean length of hospital stay was 22 ± 8.8 days in excision group (case 2 excluded) and 14.14 ± 4.91 days in en bloc group (P > .05). In en bloc group, six patients had minor injuries of the duodenum, which were repaired by direct suture; one patient had a larger and deeper duodenal defect that was repaired with jejunal loop seromuscular patching. Postoperative complications included four cases of grade B pancreatic fistula and two of intra-abdominal residual infection. There was no statistically difference in incidence of postoperative complications between two groups (P > .05). All patients were followed up for a mean of 26.39 ± 9.40 months. There was no tumor recurrence, metastasis, duodenal or bile duct stricture or obstruction.

CONCLUSIONS

Complete resection of pancreatic parenchyma in the vicinity of the accessory papilla is feasible and safe in DPPHRt. The repair of duodenal injuries should be tailored to individual cases, utilizing direct suturing or jejunal loop seromuscular patching. Clinical Trials Platform Registration Number: NCT06763250.