Duodenum-preserving pancreatic head resection: two case reports with medical video

Abstract

With the wide acceptance of the concept of damage control surgery and organ function preservation, duodenum-preserving pancreatic head resection (DPPRH) is commonly advocated to patients with benign and low malignant neoplasms. But because of complex local anatomy and blood supply, difficulty of operation, and high postoperative complications such as biliary and duodenal ischemia, the case reports are rare. We described two cases of DPPHR here, with total pancreatic head resection and pancreastic gastric anastomosis performed for one patient with serous cystadenoma of the pancreatic head, and total pancreatic head resection and pancreaticojejunostomy performed for the other patient of pancreatitis with pancreatic head mass. For case 1, acute upper digestive tract hemorrhage occurred one week after operation, and was cured and discharged after treatment with acid, hemostasis and somatostatin. Case 2 had Grade A pancreatic fistula complication after the operation, and was recovered and discharged after conservative treatment. The main points of the DPPHR procedure is the en bloc removal of the pancreatic head and the pathologic tissue, ensuring the blood supply of the duodenum and the inferior extremity of the common bile duct, to prevent the ischemia damage of the duodenum and bile duct. Key words: Pancreatic neoplasms; Pancreatitis, chronic; Pancreaticoduodenectomy; Duodenum-preserving pancreatic head resection