DUODENUM-PRESERVING PANCREAS HEAD RESECTION FOR CHRONIC PANCREATITIS -REPORT OF TWO CASES-

Abstract

Severe pain deriving chronic pancreatitis is often unable to be contrtolled by non-surgical treatments, therefore surgical treatment is required for such patients. We had been performed pancreaticoduodenectomy for those patients whose main lesion was located in the head of the pancreas and the main pancreatic duct did not dilate in the body or tail of the pancreas until 1990. Since Beger reported duodenum-preserving pancreas head resection (DpPHR) in 1980, various modified DpPHRs have been attempted in several ways that are in discuss about their procedures and the principles. We also performed DpPHR in a different way on two cases of chronic pancreatitis with a lesion localized in the head. On endoscopic retrograde cholangio-pancreatogram (ERCP), each case revealed dilatation of the main pancreatic duct in the head and complained of severe abdominal pain. Preoperative diagnosis of one case was chronic pancreatitis localized in the head of the pancreas, and the other was suspected that the tumor was localized in the main pancreatic duct. Kocher's maneuver was not employed in both cases, and the all extrahepatic biliary tract was preserved. Reconstruction was made by an end to side anastomosis between the Roux-en-Y jejunal limb and the body of the divided pancreas. The two patients have been well up to now. Although it is still controversial in the maneuver, DpPHR for preserving the natural gastrointestinal function greatly contributes to the patient's quality of life.