Total pancreatic head resection with duodenum and bile duct preserving: a report of 31 patients

Objective To investigates the role of duodenum and bile duct preserving pancreatic head resection (DBPPHR) in treatment of benign or low-grade malignant diseases located in the head of pancreas. Methods The clinical data of 31 patients who underwent DBPPHR between April 2012 to May 2016 in Zhejiang Provincial People's Hospital and Zhangzhou Municipal Hospital of Fujian Province were analyzed retrospectively. Results Of the 31 patients, 4 patients underwent laparoscopic DBPPHR. One patient in the open group was converted to pancreaticoduodenectomy. For the open group, the mean operation time was (165.3±63.6) min; the mean estimated blood loss was (258.1±156.9) ml; and the mean postoperative stay was (11.7±6.3) days. The postoperative complications included 1 reoperation due to postoperative bleeding, 1 bile leakage and 13 patients developed grade A pancreatic fistula (48.2%). For the laparosco-pic group, the mean operation time was 350.0 (280.0~450.0) min; the mean estimated blood loss was 425.0 (250.0~600.0) ml; and the mean postoperative stay was 14 days. Three patients developed post-operative pancreatic fistula (grade A). The pathological diagnosis were: 12 patients with pancreatolithiasis, 8 patients with serous cystadenoma, 4 patients with branched intraductal papillary mucinous neoplasm, 5 patients with neuroendocrine tumor and 2 patients with mucinous cystadenoma. The follow-up period was 1~48 month, and there was no patient with diabetes or diarrhea. Conclusions DBPPHR was safe and efficacious. It is less invasive to treat benign or low-grade malignant diseases located in the head of pancreas. Key words: Pancreatic duct stone; Cystic-solid lesion, pancreas; Chronic pancreatitis; Duodenum preserving pancreatic head resection; Laparoscopic surgery