Pancreas-Sparing Duodenectomy: How I Do It

Abstract

Duodenal lesions are most often resected with a Whipple pancreaticoduodenectomy (PD) to facilitate safe resection with adequate surgical margins. However, pancreas-preserving total duodenectomy (PPTD) is feasible in a subset of highly selected patients in whom malignant disease has been fully excluded. This chapter describes the clinical indications and operative technique of PPTD. Complete or partial resection of the duodenum with preservation of the head of the pancreas reduces the theoretic risks of pancreatic insufficiency. PPTD eliminates the need for pancreatic resection and is associated with good absorptive capacity, weight gain, and quality of life. It may reduce the risk of subsequent malignancy over other local or endoscopic resections, but long-term surveillance is still required. In experienced centers, PPTD is an additional strategy for the resection of benign duodenal lesions.