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Die Technik der pankreaserhaltenden Duodenektomie

Technique of pancreas-preserving duodenectomy

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Zusammenfassung

Transduodenal chirurgisch nicht abtragbare gutartige Duodenaltumore oder endoskopisch nicht überschaubare Ausprägungen einer Duodenaladenomatose bei Patienten mit familiärer adenomatöser Polyposis coli (FAP) werden bislang überwiegend mittels partieller Pankreatikoduodenektomie versorgt. Eine Alternative zu diesem Vorgehen stellt die pankreaserhaltende Duodenektomie dar. Diese Technik ermöglicht die Entfernung des gesamten Zwölffingerdarmes unter Schonung des Bauchspeicheldrüsenkopfes. Indikationen für diese Technik sind ausgedehnte oder papillennahe, nicht sicher im Gesunden zu resezierende gutartige Tumoren, multiple Duodenaladenome mit höhergradigen Epitheldysplasien bei FAP-Patienten und ausgedehnte Duodenalverletzungen in Folge von Traumen. Dieser Eingriff kann mit geringer Morbidität und guten funktionellen Ergebnissen im Vergleich zur Duodenopankreatektomie durchgeführt werden. Neben dem Erhalt der Bauchspeicheldrüse und der geringeren Anzahl zu erstellender Anastomosen bietet diese Technik den Vorteil der problemlosen endoskopischen Nachsorge.

In diesem Artikel beschreiben wir die Technik der pankreaserhaltenden Duodenektomie und stellen unsere Erfahrung mit dieser Op-Methode dar.

Abstract

Even in pancreatic surgery, as in other organs, there is a tendency towards subtle organ-preserving techniques. Benign duodenal tumors which cannot be resected transduodenally or multiple dysplastic duodenal adenomas in patients with familial adenomatous polyposis (FAP) usually require partial pancreaticoduodenectomy. However, pancreas-preserving duodenectomy may represent a viable alternative. This technique allows for the resection of the entire duodenum without resection of the pancreatic head. Large duodenal adenomas, multiple adenomas with dysplasia in patients with FAP, and based on the literature extended duodenal injury after trauma may represent indications for this surgical technique. Compared with duodenopancreatectomy, this intervention can be performed with a comparably low morbidity and leads to good functional results. Beside the preservation of pancreatic parenchyma and the reduction of the number of anastomoses, this technique offers the advantage of uncomplicated endoscopic follow-up.

In this article we describe the surgical technique of pancreas-preserving duodenectomy and our experience with this intervention.

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Authors and Affiliations

  1. Abteilung für Allgemein-, Viszeral- und Unfallchirurgie, Universität Heidelberg

    J. Köninger, H. Friess, M. Kadmon &  M. W. Büchler

  2. Klinik für Viszerale und Transplantationschirurgie der Universität Bern, Inselspital Bern

    M. Wagner

  3. Abteilung für Allgemein-, Viszeral- und Unfallchirurgie, Chirurgische Klinik, Im Neuenheimer Feld 110, 69120 , Heidelberg

    M. W. Büchler

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  1. J. Köninger
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  2. H. Friess
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  3. M. Wagner
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  4. M. Kadmon
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  5. M. W. Büchler
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Correspondence to M. W. Büchler.

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Köninger, J., Friess, H., Wagner, M. et al. Die Technik der pankreaserhaltenden Duodenektomie. Chirurg 76, 273–281 (2005). https://doi.org/10.1007/s00104-004-0992-8

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