Duodenum-preserving pancreatoduodenostomy. A new technique for complete excision of the head of the pancreas with preservation of biliary and alimentary integrity.

A new technique for complete excision of the head of the pancreas with preservation of the biliary and digestive tract is described. A series of 11 patients with chronic pancreatitis, pancreatic divisum, or a low-grade malignancy (mucus-producing pancreatic cancer) who underwent the procedure is reported. Previously described techniques for "duodenum-preserving pancreatic resection" differ from ours in two ways. First, other techniques accomplished only a "partial resection", retaining a rim of pancreas along the duodenum, and second, the pancreatoenteric anastomosis utilized a Roux-en-Y jejunal loop. Our procedure permits complete resection of the pancreatic head, which in turn permits a pancreatoduodenal anastomosis. This preserves the normal physiology of pancreatic digestive function. To assure an adequate blood supply to the duodenum, retroperitoneal vessels must be preserved by avoiding Kocher's maneuver, and the posterior superior pancreatoduodenal artery must also be preserved. This operation was successfully performed in 8 consecutive patients when these provisos were adhered to.