Duodenum-Preserving Head Resection: A Standard Operation for Chronic Pancreatitis

Abstract

Duodenum-preserving head resection of the pancreas has become a standard surgical procedure in benign lesions of the head of the pancreas. In patients with chronic pancreatitis and an inflammatory mass in the head of the pancreas, duodenum-preserving head resection offers major advantages in comparison to the Whipple resection: conservation of the stomach, duodenum, and biliary tree, and minimal restriction of endocrine pancreatic function. In 380 patients with chronic pancreatitis and an inflammatory mass, the duodenum-preserving head resection was carried out with a median postoperative hospitalization of 13.9 days, a frequency of reoperation of 5.3%, and a hospital mortality of 0.8%. The duodenum-preserving subtotal pancreatic head resection resulted in an improved glucose metabolism in 9% of the patients, preoperatively suffering latent or insulin-dependent diabetes. Only 2% of the patients showed deterioration with newly developed diabetes mellitus in the early postoperative phase. The late mortality after a median follow-up of more than 6 years is around 6%. In terms of the disease chronic pancreatitis, duodenum-preserving head resection leads to an interruption of the progression of the chronic inflammation of the pancreas.