Pancreas sparing duodenectomy as an emergency procedure

Five patients underwent emergency pancreas sparing duodenal excisions. Re-implantation of the papilla of Vater or the papilla with a surrounding mucosal patch was performed in two patients. In one, the procedure was further supplemented with a duodenocholangiostomy, stapled pyloric exclusion and enterogastrostomy to defunction the pylorus. In another three patients, distal duodenal excisions were done.In four patients, an uneventful recovery was made. One patient died following a myocardial infarction. The surgery lasted meanly 160 minutes with average blood loss of approximately 500 milliliters. The mean hospital stay was 12 days. Enteral nutrition was introduced within the 20 hours after the surgery. Long term follow-up of all surviving patients confirmed a good outcome and normal nutritional status.Based on the presented series of patients, we suggest that pancreas-sparing duodenectomy can be considered in selected patients with laceration of the duodenum deemed unsuitable for surgical reconstruction.In recent years a pancreas-sparing duodenal excision (PSD) was introduced for the treatment of certain duodenal pathologies. This technique consists of total duodenal excision including the papilla of Vater with sparing of adjacent tissues, particularly pancreatic parenchyma and the distal biliary and pancreatic ducts.PSD is less invasive than the formal pancreatico-duodenectomy and is indicated in selected cases of benign or traumatic lesions of the duodenum [1-3]. The benefits of this technique were described recently in patients with benign duodenal tumours [4,5]. Partial excisions of the duodenum to treat various malignant tumours involving the duodenal wall are also widely described in the literature [2,6-8]. The generous blood supply that remains, despite partially resecting the first two parts of duodenum, greatly assists in the success of closure by simple suturing. Under some circumstances it is necessary to resect the third and fourth part of the duodenum a