Pancreas-sparing duodenectomy with preservation of peripapillary part of duodenal wall: a new option of surgical treatment for duodenal tumor lesions

Abstract

Currently, with duodenal tumor lesion (duodenum), the possibility of performing economical operations that significantly improve the immediate results and quality of life of patients is increasingly being considered as an alternative to gastropancreatoduodenal resection. using the example of clinical observation, the article presents a new type of economical surgical intervention – duodenectomy with preservation of the peripapillary flap. The operation was performed in a patient with cancer of the resected stomach with a low spread of the tumor along the wall of the duodenum. At the control examination 9 months after the operation, the patient’s condition is satisfactory, without signs of impaired biliodynamics and passage of food through the intestinal tube. The proposed method differs from the existing prototype (papilloservative duodenectomy) by preserving the peripapillary flap of the duodenal wall.The insertion into the jejunum of not the fater papilla, but the surrounding wall of the duodenum eliminates its deformation and violation of patency and provides greater reliability of the formed suture, and the preservation of the small duodenal papilla with an additional pancreatic duct of Santorini can help reduce the frequency of postoperative pancreatitis and pancreonecrosis. In addition to cases of low lesions of the duodenum in gastric cancer, the method can be used in patients with non-epithelial and neuroendocrine tumors, as well as in secondary tumor invasion of the duodenum from the outside. The criterion limiting the performance of this type of operation is the distance from the edge of the tumor to the fater papilla less than 2.0–2.5 cm.Duodenectomy with preservation of the peripapillary flap can be considered as a way to improve the safety and quality of life in the surgical treatment of patients with a tumor lesion of the duodenum.