Successful treatment of large adenoma extending close to the papilla in the duodenum by laparoscopy-assisted pancreas-sparing duodenectomy

Asian Journal of Endoscopic Surgery
N AbeM Sugiyama

Abstract

A 54-year-old man had a 65-mm infrapapillary, circular, and laterally spreading tubular adenoma in the distal second and proximal third parts of the duodenum. The papilla was 15 mm from the proximal margin of the tumor. Because the patient requested organ-preserving laparoscopic surgery, we conducted laparoscopy-assisted pancreas-sparing duodenectomy (LAPSD). LAPSD consists of five major procedures: (i) laparoscopic wide Kocher maneuver and transection of the proximal jejunum; (ii) laparoscopic separation of the duodenum from the pancreas; (iii) creation of a small upper median laparotomy; (iv) extracorporeal completion of the segmental duodenectomy; and (v) extracorporeal intestinal reconstruction. The postoperative course was uneventful, and the patient was discharged on postoperative day 8. Histopathological examination revealed that the circumferential margin of the specimen was negative for tumor cells. LAPSD provided a clear margin without damaging the papilla and eliminated the possibility of peritoneal or port-site seeding of tumor cells because part of the procedure was performed extracorporeally. LAPSD is a useful alternative to pancreatoduodenectomy in patients with a large adenoma extending close to the papilla in t...Continue Reading

References

Mar 1, 1986·Annals of Surgery·D P RyanA L Warshaw
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May 24, 2003·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Alexander PerezEdward E Whang
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Apr 23, 2014·Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society·Nobutsugu AbeMasanori Sugiyama
May 8, 2015·Asian Journal of Endoscopic Surgery·Nobutsugu AbeMasanori Sugiyama

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Citations

Jul 12, 2017·World Journal of Gastroenterology : WJG·W Kyle MitchellDileep N Lobo

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