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Segmental Duodenal Resections: Toward Defining Indications, Complexity, and Coding

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Segmental resections of the duodenum are uncommonly performed and are technically challenging due to intimate relationships with the biliary tree, pancreas, and superior mesenteric vessels. The objective of this study was to assess indications, operative strategy, and outcomes of duodenal resections and to advocate that this form of resection deserves its own unique Current Procedural Terminology (CPT) and Relative Value Unit (RVU) structure.

Methods

Patients undergoing isolated and partial duodenal resection from 2008-2023 at University of Tennessee Health Science Center affiliated hospitals were retrospectively reviewed. Factors examined included clinical presentation, diagnostic evaluation, operative time, and technique, 90-day morbidity and mortality, and pathologic and survival outcomes.

Results

Thirty-one patients were identified with majority female and a median age of 61. Diagnostic studies included computed tomography and upper (including push) endoscopy. Reconstruction most often involved side-to-side duodenojejunostomy following distal duodenal resection. Intraoperative evaluation (IOE) of the biliary tree was utilized to assess and protect pancreaticobiliary structures in eleven patients. Median operative time was 206 min, increasing to 236 min when IOE was necessary. Procedure-related morbidity was 23% with one 90-day mortality. Median postoperative length of stay was 9 days. Pathology included benign adenoma, adenocarcinoma, GIST, neuroendocrine neoplasms, and erosive metastatic deposit.

Conclusion

Duodenal resections can be effectively employed to safely address diverse pathologies. These procedures are characterized by long operative times, extended hospital stays, and an incidence of postoperative complications that mimics that of pancreatic resection. This work highlights the need for modification to the CPT system to accurately define these distinct procedures for future research endeavors and development of a more accurate valuation unit.

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Data Availability

The authors confirm that the data supporting the findings of this study are available within the article and its supplementary material. Raw data that suport the findings of this study are available from the corresponding author, upon reasonable request.

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Authors and Affiliations

  1. Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA

    Devanshi D. Patel MD

  2. Department of Surgery, Veterans Administration Hospital, Memphis, TN, USA

    Ahmad B. Abdulkarim MD

  3. Department of Surgery, Baptist Memorial Medical Education, 6025 Walnut Grove Road, Suite 207, Memphis, TN, 38120, USA

    Ahmad B. Abdulkarim MD & Stephen W. Behrman MD

Authors
  1. Devanshi D. Patel MD
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  2. Ahmad B. Abdulkarim MD
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  3. Stephen W. Behrman MD
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Contributions

DP and SB: conceptualization, methodology, data curation, writing and editing of the final manuscript. AA: writing and editing of the manuscript.

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Correspondence to Devanshi D. Patel MD or Stephen W. Behrman MD.

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Patel, D.D., Abdulkarim, A.B. & Behrman, S.W. Segmental Duodenal Resections: Toward Defining Indications, Complexity, and Coding. J Gastrointest Surg 27, 2373–2379 (2023). https://doi.org/10.1007/s11605-023-05837-z

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  • DOI: https://doi.org/10.1007/s11605-023-05837-z

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