Pancreas-Sparing Duodenectomy: How I Do It

  • Monica M. DuaEmail author
  • Lavina Malhotra
  • Brendan C. Visser


Duodenal lesions are most often resected with a Whipple pancreaticoduodenectomy (PD) to facilitate safe resection with adequate surgical margins. However, pancreas-preserving total duodenectomy (PPTD) is feasible in a subset of highly selected patients in whom malignant disease has been fully excluded. This chapter describes the clinical indications and operative technique of PPTD. Complete or partial resection of the duodenum with preservation of the head of the pancreas reduces the theoretic risks of pancreatic insufficiency. PPTD eliminates the need for pancreatic resection and is associated with good absorptive capacity, weight gain, and quality of life. It may reduce the risk of subsequent malignancy over other local or endoscopic resections, but long-term surveillance is still required. In experienced centers, PPTD is an additional strategy for the resection of benign duodenal lesions.


Pancreas preserving Pancreas sparing Total duodenectomy Duodenectomy Ampullojejunostomy Pancreaticojejunostomy 


  1. 1.
    Chung RS, Church JM, van Stolk R. Pancreas-sparing duodenectomy: indications, surgical technique, and results. Surgery. 1995;117(3):254–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Wig JD, Kudari A, Yadav TD, Doley RP, Bharathy KG, Kalra N. Pancreas preserving total duodenectomy for complex duodenal injury. JOP. 2009;10(4):425–8.PubMedGoogle Scholar
  3. 3.
    Kimura Y, Mukaiya M, Honma T, Okuya K, Akizuki E, Kihara C, et al. Pancreas-sparing duodenectomy for a recurrent retroperitoneal liposarcoma: report of a case. Surg Today. 2005;35(1):91–3.CrossRefPubMedGoogle Scholar
  4. 4.
    Muller MW, Dahmen R, Koninger J, Michalski CW, Hinz U, Hartel M, et al. Is there an advantage in performing a pancreas-preserving total duodenectomy in duodenal adenomatosis? Am J Surg. 2008;195(6):741–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Gupta V, Singh V, Kalra N, Vaiphei K. Pancreas sparing resection for giant hamartoma of Brunner’s glands. JOP. 2009;10(2):196–9.PubMedGoogle Scholar
  6. 6.
    Cueto J, Benotto JA, Catalina R, Vazquez-Frias JA. Large duodenal villous adenoma requiring head of the pancreas and pylorus-preserving total duodenectomy. Surg Laparosc Endosc Percutan Tech. 2005;15(4):230–2. discussion 2-3CrossRefPubMedGoogle Scholar
  7. 7.
    Mackey R, Walsh RM, Chung R, Brown N, Smith A, Church J, et al. Pancreas-sparing duodenectomy is effective management for familial adenomatous polyposis. J Gastrointest Surg. 2005;9(8):1088–93. discussion 93CrossRefPubMedGoogle Scholar
  8. 8.
    Nagai H, Hyodo M, Kurihara K, Ohki J, Yasuda T, Kasahara K, et al. Pancreas-sparing duodenectomy: classification, indication and procedures. Hepato-Gastroenterology. 1999;46(27):1953–8.PubMedGoogle Scholar
  9. 9.
    Al-Sarireh B, Ghaneh P, Gardner-Thorpe J, Raraty M, Hartley M, Sutton R, et al. Complications and follow-up after pancreas-preserving total duodenectomy for duodenal polyps. Br J Surg. 2008;95(12):1506–11.CrossRefPubMedGoogle Scholar
  10. 10.
    Otsuka S, Sugiura T, Uesaka K. Acute obstructive pancreatitis after pancreas-sparing total duodenectomy in a patient with pancreas divisum: a case report. Surg Case Rep. 2016;2(1):126.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Imamura M, Komoto I, Doi R, Onodera H, Kobayashi H, Kawai Y. New pancreas-preserving total duodenectomy technique. World J Surg. 2005;29(2):203–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Takagi H, Miyairi J, Hata M, Tuboi J, Kamijou T, Nakajima K, et al. Multiple somatostatin- and gastrin-containing carcinoids of the duodenum: report of a case treated by pancreas-sparing duodenectomy. Hepato-Gastroenterology. 2003;50(51):711–3.PubMedGoogle Scholar
  13. 13.
    Tsiotos GG, Sarr MG. Pancreas-preserving total duodenectomy. Dig Surg. 1998;15(5):398–403.CrossRefPubMedGoogle Scholar
  14. 14.
    Wang SE, Chen SC, Shyr BU, Shyr YM. Comparison of modified Blumgart pancreaticojejunostomy and pancreaticogastrostomy after pancreaticoduodenectomy. HPB (Oxford). 2016;18(3):229–35.CrossRefGoogle Scholar
  15. 15.
    Liao Z, Gao R, Wang W, Ye Z, Lai XW, Wang XT, et al. A systematic review on endoscopic detection rate, endotherapy, and surgery for pancreas divisum. Endoscopy. 2009;41(5):439–44.CrossRefPubMedGoogle Scholar
  16. 16.
    Benetatos N, Ammori MB, Ammori BJ. Laparoscopic pancreas-preserving total duodenectomy for familial adenomatous polyposis. Surg Laparosc Endosc Percutan Tech. 2011;21(6):e332–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Stauffer JA, Adkisson CD, Riegert-Johnson DL, Goldberg RF, Bowers SP, Asbun HJ. Pancreas-sparing total duodenectomy for ampullary duodenal neoplasms. World J Surg. 2012;36(10):2461–72.CrossRefPubMedGoogle Scholar
  18. 18.
    Standards of Practice Committee, Adler DG, Qureshi W, Davila R, Gan SI, Lichtenstein D, et al. The role of endoscopy in ampullary and duodenal adenomas. Gastrointest Endosc. 2006;64(6):849–54.CrossRefGoogle Scholar
  19. 19.
    Skipworth JR, Morkane C, Raptis DA, Vyas S, Olde Damink SW, Imber CJ, et al. Pancreaticoduodenectomy for advanced duodenal and ampullary adenomatosis in familial adenomatous polyposis. HPB (Oxford). 2011;13(5):342–9.CrossRefGoogle Scholar
  20. 20.
    de Castro SM, van Eijck CH, Rutten JP, Dejong CH, van Goor H, Busch OR, et al. Pancreas-preserving total duodenectomy versus standard pancreatoduodenectomy for patients with familial adenomatous polyposis and polyps in the duodenum. Br J Surg. 2008;95(11):1380–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Monica M. Dua
    • 1
    Email author
  • Lavina Malhotra
    • 1
  • Brendan C. Visser
    • 1
  1. 1.Division of Surgical Oncology, Department of SurgeryStanford University School of MedicineStanfordUSA

Personalised recommendations