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Successful treatment of large adenoma extending close to the papilla in the duodenum by laparoscopy‐assisted pancreas‐sparing duodenectomy
Author(s) -
Abe Nobutsugu,
Hashimoto Yoshikazu,
Kawaguchi Shouhei,
Shimoyama Hayato,
Kojima Youhei,
Yoshimoto Eri,
Kondo Eri,
Ohki Atsuko,
Takeuchi Hirohisa,
Nagao Gen,
Suzuki Yutaka,
Masaki Tadahiko,
Mori Toshiyuki,
Sugiyama Masanori
Publication year - 2016
Publication title -
asian journal of endoscopic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.372
H-Index - 18
eISSN - 1758-5910
pISSN - 1758-5902
DOI - 10.1111/ases.12246
Subject(s) - medicine , major duodenal papilla , duodenum , laparotomy , laparoscopy , surgery , extracorporeal , adenoma , tubular adenoma , pancreas , general surgery , cancer , colorectal cancer , colonoscopy
A 54‐year‐old man had a 65‐mm infrapapillary, circular, and laterally spreading tubular adenoma in the distal second and proximal third parts of the duodenum. The papilla was 15 mm from the proximal margin of the tumor. Because the patient requested organ‐preserving laparoscopic surgery, we conducted laparoscopy‐assisted pancreas‐sparing duodenectomy ( LAPSD ). LAPSD consists of five major procedures: (i) laparoscopic wide Kocher maneuver and transection of the proximal jejunum; (ii) laparoscopic separation of the duodenum from the pancreas; (iii) creation of a small upper median laparotomy; (iv) extracorporeal completion of the segmental duodenectomy; and (v) extracorporeal intestinal reconstruction. The postoperative course was uneventful, and the patient was discharged on postoperative day 8. Histopathological examination revealed that the circumferential margin of the specimen was negative for tumor cells. LAPSD provided a clear margin without damaging the papilla and eliminated the possibility of peritoneal or port‐site seeding of tumor cells because part of the procedure was performed extracorporeally. LAPSD is a useful alternative to pancreatoduodenectomy in patients with a large adenoma extending close to the papilla in the duodenum.