World Journal of Surgery

, Volume 42, Issue 12, pp 4005–4013 | Cite as

Laparoscopic Partial Sleeve Duodenectomy for the Infra-Ampullary Gastrointestinal Stromal Tumors of the Duodenum

  • Sung Hoon Choi
  • Jiae Park
  • Chang Moo KangEmail author
  • Woo Jung Lee
Original Scientific Report with Video



Although organ-preserving operations are regarded as effective strategies for duodenal gastrointestinal stromal tumors (GISTs), laparoscopic partial sleeve duodenectomy (lap PSD) has not been fully evaluated. The aims of this study were to evaluate the effectiveness and technical feasibility of lap PSD.

Study design

Between January 2011 and March 2016, we reviewed 13 patients who underwent laparoscopic approach among 22 patients who underwent PSD. PSD for the infra-ampullary lesions was defined as infra-ampullary duodenal resection including the first portion of the jejunum. After resection, all patients underwent reconstruction via side-to-side duodenojejunostomy.


The total mean operation time was 273 min (range 160–346 min), and estimated mean blood loss was 80 ml (range scanty-200 ml). One patient was converted to open laparotomy because of mesocolonic tumor involvement. The median postoperative hospital stay was 10.5 days (range 4–36 days). There were no postoperative mortalities. Postoperative complications included 2 instances of delayed gastric emptying (DGE), 1 duodenojejunostomy stricture, and 2 intestinal obstructions. No patient was treated with adjuvant therapy. One patient experienced hepatic metastasis 28 months after surgery during a mean follow-up period of 48.6 months.


Lap PSD might be an oncologically effective strategy for duodenal GIST, and the laparoscopic approach is a technically feasible and appealing surgical modality in terms of safety and perioperative results. However, DGE and anastomosis strictures are concerns for postoperative complications, which need to be further investigated.



The authors would like to thank to Dong-Su Jang (Medical Illustrator, Medical Research Support Section, Yonsei University College of Medicine, Seoul, Korea) for his help with the figures.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest or financial ties to disclose.

Supplementary material

268_2018_4707_MOESM1_ESM.wmv (84 mb)
Supplementary material 1 (WMV 86065 kb)


  1. 1.
    Gold JS, Dematteo RP (2006) Combined surgical and molecular therapy: the gastrointestinal stromal tumor model. Ann Surg 244:176–184CrossRefGoogle Scholar
  2. 2.
    Miettinen M, Kopczynski J, Makhlouf HR et al (2003) Gastrointestinal stromal tumors, intramural leiomyomas, and leiomyosarcomas in the duodenum: a clinicopathologic, immunohistochemical, and molecular genetic study of 167 cases. Am J Surg Pathol 27:625–641CrossRefGoogle Scholar
  3. 3.
    Winfield RD, Hochwald SN, Vogel SB et al (2006) Presentation and management of gastrointestinal stromal tumors of the duodenum. Am Surg 72:719–722; discussion 722–713Google Scholar
  4. 4.
    DeMatteo RP, Lewis JJ, Leung D et al (2000) Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 231:51–58CrossRefGoogle Scholar
  5. 5.
    Goh BK, Chow PK, Kesavan S et al (2008) Outcome after surgical treatment of suspected gastrointestinal stromal tumors involving the duodenum: is limited resection appropriate? J Surg Oncol 97:388–391CrossRefGoogle Scholar
  6. 6.
    Goh BK, Chow PK, Ong HS et al (2005) Gastrointestinal stromal tumor involving the second and third portion of the duodenum: treatment by partial duodenectomy and Roux-en-Y duodenojejunostomy. J Surg Oncol 91:273–275CrossRefGoogle Scholar
  7. 7.
    Bourgouin S, Hornez E, Guiramand J et al (2013) Duodenal gastrointestinal stromal tumors (GISTs): arguments for conservative surgery. J Gastrointest Surg 17:482–487CrossRefGoogle Scholar
  8. 8.
    Maher MM, Yeo CJ, Lillemoe KD et al (1996) Pancreas-sparing duodenectomy for infra-ampullary duodenal pathology. Am J Surg 171:62–67CrossRefGoogle Scholar
  9. 9.
    Poves I, Burdio F, Alonso S et al (2011) Laparoscopic pancreas-sparing subtotal duodenectomy. JOP 12:62–65PubMedGoogle Scholar
  10. 10.
    Ammori BJ (2002) Laparoscopic pancreas-preserving distal duodenectomy for duodenal stricture related to nonsteroidal antiinflammatory drugs (NSAIDs). Surg Endosc 16:1362–1363CrossRefGoogle Scholar
  11. 11.
    Stauffer JA, Raimondo M, Woodward TA et al (2013) Laparoscopic partial sleeve duodenectomy (PSD) for nonampullary duodenal neoplasms: avoiding a whipple by separating the duodenum from the pancreatic head. Pancreas 42:461–466CrossRefGoogle Scholar
  12. 12.
    Kokosis G, Ceppa EP, Tyler DS et al (2015) Laparoscopic duodenectomy for benign nonampullary duodenal neoplasms. Surg Laparosc Endosc Percutan Tech 25:158–162CrossRefGoogle Scholar
  13. 13.
    Kim SH, Kang CM, Lee WJ (2013) Laparoscopic pancreas-sparing subtotal duodenectomy in gastrointestinal stomal tumor of the duodenum. Ann Surg Oncol 20:547CrossRefGoogle Scholar
  14. 14.
    Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196CrossRefGoogle Scholar
  15. 15.
    Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768CrossRefGoogle Scholar
  16. 16.
    Fletcher CD, Berman JJ, Corless C et al (2002) Diagnosis of gastrointestinal stromal tumors: a consensus approach. Int J Surg Pathol 10:81–89CrossRefGoogle Scholar
  17. 17.
    Fletcher CD, Berman JJ, Corless C et al (2002) Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 33:459–465CrossRefGoogle Scholar
  18. 18.
    Miki Y, Kurokawa Y, Hirao M et al (2010) Survival analysis of patients with duodenal gastrointestinal stromal tumors. J Clin Gastroenterol 44:97–101CrossRefGoogle Scholar
  19. 19.
    Yang F, Jin C, Du Z et al (2013) Duodenal gastrointestinal stromal tumor: clinicopathological characteristics, surgical outcomes, long term survival and predictors for adverse outcomes. Am J Surg 206:360–367CrossRefGoogle Scholar
  20. 20.
    Zhou B, Zhang M, Wu J et al (2013) Pancreaticoduodenectomy versus local resection in the treatment of gastrointestinal stromal tumors of the duodenum. World J Surg Oncol 11:196CrossRefGoogle Scholar
  21. 21.
    Connolly EM, Gaffney E, Reynolds JV (2003) Gastrointestinal stromal tumours. Br J Surg 90:1178–1186CrossRefGoogle Scholar
  22. 22.
    Tien YW, Lee CY, Huang CC et al (2010) Surgery for gastrointestinal stromal tumors of the duodenum. Ann Surg Oncol 17:109–114CrossRefGoogle Scholar
  23. 23.
    Buchs NC, Bucher P, Gervaz P et al (2010) Segmental duodenectomy for gastrointestinal stromal tumor of the duodenum. World J Gastroenterol 16:2788–2792CrossRefGoogle Scholar
  24. 24.
    Miettinen M, Furlong M, Sarlomo-Rikala M et al (2001) Gastrointestinal stromal tumors, intramural leiomyomas, and leiomyosarcomas in the rectum and anus: a clinicopathologic, immunohistochemical, and molecular genetic study of 144 cases. Am J Surg Pathol 25:1121–1133CrossRefGoogle Scholar
  25. 25.
    Tsiotos GG, Sarr MG (1998) Pancreas-preserving total duodenectomy. Dig Surg 15:398–403CrossRefGoogle Scholar
  26. 26.
    Montorsi M, Opocher E, Santambrogio R et al (1999) Original technique for small colorectal tumor localization during laparoscopic surgery. Dis Colon Rectum 42:819–822CrossRefGoogle Scholar
  27. 27.
    Ryu KW, Lee JH, Choi IJ et al (2003) Preoperative endoscopic clipping: localizing technique of early gastric cancer. J Surg Oncol 82:75–77CrossRefGoogle Scholar
  28. 28.
    Beretvas RI, Ponsky J (2001) Endoscopic marking: an adjunct to laparoscopic gastrointestinal surgery. Surg Endosc 15:1202–1203CrossRefGoogle Scholar
  29. 29.
    Nagata K, Endo S, Tatsukawa K et al (2008) Intraoperative fluoroscopy vs. intraoperative laparoscopic ultrasonography for early colorectal cancer localization in laparoscopic surgery. Surg Endosc 22:379–385CrossRefGoogle Scholar
  30. 30.
    Kim HI, Hyung WJ, Lee CR et al (2011) Intraoperative portable abdominal radiograph for tumor localization: a simple and accurate method for laparoscopic gastrectomy. Surg Endosc 25:958–963CrossRefGoogle Scholar
  31. 31.
    Hyung WJ, Lim JS, Cheong JH et al (2005) Intraoperative tumor localization using laparoscopic ultrasonography in laparoscopic-assisted gastrectomy. Surg Endosc 19:1353–1357CrossRefGoogle Scholar
  32. 32.
    Kim IY, Cho NC, Kim DS et al (2003) Laparoscopic duodenojejunostomy for management of superior mesenteric artery syndrome: two cases report and a review of the literature. Yonsei Med J 44:526–529CrossRefGoogle Scholar
  33. 33.
    Tanaka E, Kim M, Lim JS et al (2015) Usefulness of laparoscopic side-to-side duodenojejunostomy for gastrointestinal stromal tumors located at the duodenojejunal junction. J Gastrointest Surg 19:313–318CrossRefGoogle Scholar
  34. 34.
    Masrur M, Gheza F, Raimondi P et al (2012) Robot-assisted subtotal pancreas-preserving duodenectomy. JSLS 16:654–659CrossRefGoogle Scholar
  35. 35.
    Umemoto K, Nakanishi Y, Murakawa K et al (2017) Laparoscopic segmental duodenectomy for a gastrointestinal stromal tumor located in the second portion of the duodenum: A case report. Asian J Endosc SurgGoogle Scholar
  36. 36.
    Takahashi T (2012) Mechanism of interdigestive migrating motor complex. J Neurogastroenterol Motil 18:246–257CrossRefGoogle Scholar
  37. 37.
    Tanaka T, Mizumoto A, Mochiki E et al (2004) Relationship between intraduodenal 5-hydroxytryptamine release and interdigestive contractions in dogs. J Smooth Muscle Res 40:75–84CrossRefGoogle Scholar
  38. 38.
    Courvoisier T, Donatini G, Faure JP et al (2015) Primary versus secondary delayed gastric emptying (DGE) grades B and C of the International Study Group of Pancreatic Surgery after pancreatoduodenectomy: a retrospective analysis on a group of 132 patients. Updates Surg 67:305–309CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Sung Hoon Choi
    • 1
  • Jiae Park
    • 2
  • Chang Moo Kang
    • 3
    Email author
  • Woo Jung Lee
    • 3
  1. 1.Division of Hepatobiliary and Pancreas, Department of Surgery, CHA Bundang Medical CenterCHA UniversitySeongnamKorea
  2. 2.Department of SurgeryNational Police HospitalSeoulKorea
  3. 3.Pancreatobiliary Cancer CenterYonsei Cancer Center, Severance HospitalSeoulKorea

Personalised recommendations