Pancreas preserving duodenectomy for duodenal polyposis in familial adenomatous polyposis

Keywords: familial adenomatous polyposis;, duodenal polyposis, pancreas preserving duodenectomy, duodenal adenocarcinoma

Abstract

Duodenal polyposis is common in familial adenomatous polyposis with a significant associated lifetime risk of cancer. Screening and regular surveillance is recommended, guided by the Spigelman stage. Pancreas preserving duodenectomy (PPD) is the preferred operation in patients needing removal of the whole duodenum. This presentation demonstrates the technique of PPD with particular emphasis on the resection and ampullary reconstruction. Initial early feeding tube placement through the cystic duct stump into the duodenum enables identification of the papilla and pancreatic duct as well as subsequent dissection. Separate trans-anastomotic pancreatic and biliary stents facilitate creation and patency of the pancreato-biliary anastomosis. The operation has similar outcomes compared to pancreaticoduodenectomy, however, the anatomical reconstruction allows for postoperative surveillance.

Author Biographies

J Lindemann, University of Cape Town

Surgical Gastroenterology Unit, Division of General Surgery, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, South Africa and Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, United States of America

J E J Krige, University of Cape Town

Surgical Gastroenterology Unit, Division of General Surgery, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, South Africa

E Jonas, University of Cape Town

Surgical Gastroenterology Unit, Division of General Surgery, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, South Africa

Published
2020-09-01
How to Cite
Lindemann, J., Krige, J., & Jonas, E. (2020). Pancreas preserving duodenectomy for duodenal polyposis in familial adenomatous polyposis. South African Journal of Surgery, 58(3), 161. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/3378
Section
Case Reports