Pancreas-preserving total duodenectomy: a 10-year experience

Background Traditionally, severe pathology of the duodenum has been treated by a pancreaticoduodenectomy using Whipple's operation. Pancreas-preserving total duodenectomy (PPTD) was introduced in the late 1990s as an alternative to Whipple's operation for selected diseases of the duodenum. We report our 10 years' experience with this operation. Methods In the period from 1999 to 2010 13 patients (mean age 50 years) underwent PPTD. Ten patients had duodenal adenomatosis (Spigelman stage IV). Two patients had large solitary tubulovillous adenomas, and one patient had multiple duodenal gastrointestinal stromal tumor lesions. Results No mortality was observed. Six patients (46%) had a total of ten postoperative complications. Three patients (23%) had leakage of the ampullo-jejunostomy anastomosis, and one patient (8%) had leakage of the duodeno-jejunostomy anastomosis; all were treated conservatively with good results. One patient had recurrent episodes of pancreatitis, which disappeared spontaneously 3 months after operation. Three patients suffered from wound dehiscence, and two patients had postoperative pneumonia. Mean hospital admittance was 19 days (range 9-50 days). All patients were well at a mean follow-up of 56 months (range 2-134 months). Conclusion Pancreas-preserving total duodenectomy appears to be a safe and valuable treatment option for patients with selected diseases of the duodenum.