Pancreas-preserving duodenal resections as a surgery of choice for the isolated form of cystic dystrophy of the duodenal wall (pure form of groove pancreatitis)

Abstract

Background:Management of the isolated form of cystic dystrophy of the duodenal wall (CDDW), or pure form of groove pancreatitis, is controversial. Pancreatoduodenectomy is considered to be the most suitable procedure for CDDW. Pancreas-preserving procedures (PPDR) have been described as surgical options for the cases where only the duodenum has been involved. There are no studies comparing pancreas-preserving vs. pancreas-resecting procedures for this disease.Aim:To analyze the results and outcomes of PPDR and other treatment approaches to CDDW and to review the literature.Materials and methods:We performed a retrospective analysis of 82 patients with CDDW who received treatment from February 2004 to April 2019. We compared short-term and long-term results of treatment of 15 patients with isolated CDDW after PPDR and 42 patients with CDDW after pancreatoduodenectomy.Results:The preoperative diagnosis was correct in 81 of the cases (98.8%). The patients experienced abdominal pain (100%), weight loss (76%), vomiting (30%), and jaundice (18%). CT, MRI, and endoUS were the most useful diagnostic modalities. Twelve patients with CDDW took conservative treatment due to rejection of the operation. The other patients underwent cystoenterostomies (8), duodenum-preserving pancreatic head (DPPH) resections (6), pancreatoduodenectomy (42) and PPDR (15) with zero mortality. Full pain control was achieved after PPDR in 93%, after pancreatoduodenectomy in 83%, and after draining procedures in 18% of the cases. Newly onset diabetes mellitus (7) and severe exocrine insufficiency (5) were common after pancreatoduodenectomy and never occurred after DPPH resections and PPDR. Weight gain was significantly higher after pancreatoduodenectomy and PPDR, compared to other treatment modalities.Conclusion:PPDR is the optimal surgical procedure for the isolated form of CDDW. Early detection of CDDW allows for preservation of the pancreas. The pure form of groove pancreatitis is a disease of the duodenum, and the Whipple procedure should be considered excessive for this disease.