Partial Sleeve Duodenectomy (PSD) for Duodenal Lesions

Abstract

Lesions of the duodenum that are not amenable to endoscopic resection are usually treated with pancreatoduodenectomy; however, noninvasive lesions do not require pancreatic resection and separation of the duodeno-pancreatic complex is possible. The objective of this study is to assess the feasibility and safety of pancreas sparing sleeve duodenectomy (PSD) for nonampullary lesions. A retrospective review of patients with duodenal lesions not amenable to endoscopic resection. Demographics, surgical technique and complications were analyzed. Twenty-six patients (mean age 70.9 years, 15 men, 11 women) with duodenal pathology including tubulovillous adenoma (n=13), focal adenocarcinoma arising from a tubulovillous adenoma (n=4), lymphangiolipoma (n=1), neuroendocrine tumor (n=5), GIST (n=2) and duodenal stenosis (n=1) were included. PSD with complete separation from the pancreatic head was performed laparoscopically in 25 patients and open in 1 patient. A distal PSD (infra-ampullary) was done in 20 with a side to side duodeno-jejunostomy reconstruction. Six patients underwent a proximal PSD (supra-ampullary). Of these, a pyloric-preserving procedure was done in 4 patients with a post-pyloric end-to-side duodeno-jejunostomy reconstruction distal to the ligament of Treitz (LT). The remaining 2 patients underwent a non-pyloric-preserving proximal resection with a gastro-jejunostomy reconstruction distal to the LT Mean length of stay was 4.9 days and overall morbidity was 19%. Laparoscopic PSD appears to be a safe and easily applicable technique for treatment of duodenal diseases not involving the ampulla which require separation of the duodenum from the pancreas head with sleeve resection of the duodenum and subsequent reconstruction.