Function-Preserving Laparoscopic Local Resection of Duodenal Papillary Adenomas

Summary

The present protocol describes a function-preserving laparoscopic resection technique with preoperative pancreatic and biliary stenting for duodenal papillary adenomas unsuitable for endoscopic removal. This approach ensures complete tumor excision, preserves duodenal function, minimizes complications, and achieves favorable postoperative outcomes in patients with a complex tumor presentation.

Abstract

Duodenal papillary adenomas, although rare, have significant potential for malignant transformation, necessitating precise intervention. Current surgical options for treating duodenal papillary adenomas include pancreaticoduodenectomy, endoscopic resection, and function-preserving laparoscopic resection. Although traditional pancreaticoduodenectomy has undergone substantial advancements in recent decades, it still carries a high risk of perioperative complications and mortality, making it a less preferred choice. Endoscopic resection is suitable for smaller tumors; however, it presents limitations when applied to larger tumors, potentially resulting in serious complications such as bleeding and perforation. In contrast, function-preserving laparoscopic resection of duodenal papillary tumors reduces the need for extensive organ resection or digestive tract reconstruction, thereby lowering surgical risks and better preserving digestive function. By combining preoperative placement of pancreatic duct and biliary stents with function-preserving laparoscopic resection, duodenal papillary adenomas not amenable to endoscopic removal were successfully resected without significant perioperative complications. The main procedures included preoperative placement of pancreatic duct and biliary stents; intraoperative mobilization of the descending duodenum through Kocherization; longitudinal incision of the anterolateral duodenal wall; incision along tumor margins to expose mucosal and submucosal layers; complete tumor resection along its base; and repair and reconstruction of the duodenal papilla and wall. Postoperative follow-up indicated good recovery and patient satisfaction. These findings suggest that function-preserving laparoscopic resection is a safe and feasible option for selected duodenal papillary adenomas.

Introduction

Duodenal papillary adenoma is a rare benign tumor. With the widespread adoption of endoscopic screening, the detection rate of duodenal papillary adenomas has increased in recent years. Duodenal papillary adenoma often presents with nonspecific symptoms in the early stages¹. As a precancerous tumor, it has the potential to progress to adenocarcinoma, posing significant challenges to patient treatment and survival.

Tumor resection remains the most effective treatment option. Currently, available surgical options include pancreaticoduodenectomy (PD), function-preserving local resection (LR), and endoscopic resection (E....

Protocol

The operation was routine and conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of Meizhou People's Hospital. Informed consent was obtained from the patient's authorized representatives. Details of the reagents and equipment used are listed in the Table of Materials.

1. Patient selection

1. Apply the following inclusion criteria: benign duodenal papillary adenomas, adenomas exhibiting local malignancy without lymph node metastasis, and patients unable to tolerate pancreaticoduodenectomy.
2. Apply the following exclusion ....

Results

The operation was completed in 320 min with 20 mL of intraoperative hemorrhage without the need for a perioperative transfusion. The preoperatively placed pancreatic and bile ducts provided excellent guidance for the localization and reconstruction of the duodenal papilla during the operation. There were no significant short-term complications, including severe pancreatitis, cholangitis, abdominal infections, or leakage from the pancreas or bile ducts. The patient initiated nasogastric feeding with a glucose-saline solut.......

Discussion

Currently, the use of PD in treating duodenal adenomas is gradually declining, with ER or LR becoming the preferred treatment option^14,15. These procedures theoretically facilitate a more minimally invasive and safer removal of tumors while preserving the function of the duodenal papilla. However, inappropriate selection of indications may result in disastrous outcomes for patients, including severe postoperative complications such as perforation or bleeding, the.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Biliary stent	Boston Scientific	M00539260
Dissecting forceps	KANGJI	ZP485RB 330mm×Φ5
Drainage tube	Kang-Li	QH-F28
Duodenoscope	Olympus Medical Europa	TJF-260V
Endoscope	Olympus Medical Europa	CHF-BP260
Grasping forceps	KANGJI	ZP531RB 330mm×Φ5
Guidewire	Boston Scientific	M0055614
Hurricane RX Biliary Balloon Dilatation Catheter	Boston Scientific	M00535900
Laparoscope	OptoMedic	OPTO-CA214K
Laparoscope	Flocare	CH10-130
Normal Saline 3000 mL	Ke-Lun	3000ml:27g
Pancreatic stent	Cook Medical	SPSOF-5-7
Suction and Irrigation	KANGJI	Φ5/Φ10×330mm
Suture	ETHICON	VCP784D
Suture	ETHICON	5-0 PDS VIOLET 1x30" (75cm) RB-2 DA
Ultrasonic knife	An-He	AH-600