Pancreatic head resection with segmental duodenectomy and preservation of the gastroduodenal artery.

BACKGROUND/AIMS: Duodenum-preserving pancreatic head resection has been performed for benign pancreatic head diseases. Complete resection of the pancreatic head with preservation of common bile duct and the duodenum sometimes causes common bile duct or duodenal necrosis due to ischemia. We propose the simple, easy and safe procedure for complete resection of pancreatic head with segmental duodenectomy to prevent complications, which may be caused on duodenum preserving pancreatic head resection.
METHODOLOGY: Pancreatic head resection with segmental duodenectomy including minor and major papilla was performed. By conserving the right gastric artery, 5 to 7 cm of the first portion of the duodenum is preserved with good arterial circulation. In addition, by conserving the anterior inferior pancreaticoduodenal artery, the third portion and anal side of the second portion of the duodenum are preserved with good arterial circulation. Resection of the pancreatic head with 3 to 4 cm of segmental duodenectomy including minor and major papilla completes this procedure. Reconstruction of the alimentary tract is then performed with pancreatogastrostomy, end to end duodenoduodenostomy and end to side choledochoduodenostomy.
RESULTS: In 14 cases of pancreatic head diseases, chiefly benign tumors, this procedure was successfully performed without severe complications. Postoperative quality of life was quite satisfactory.
CONCLUSION: Using this procedure, complete resection of the pancreatic head for benign tumor of the pancreatic head region can be performed safely and effectively.