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Pancreas preserving distal duodenectomy: a versatile operation for a range of infra-papillary pathologies

Mitchell, W. Kyle; Thomas, Pradeep F.; Zaitoun, Abed M.; Brooks, Adam J.; Lobo, Dileep N.


W. Kyle Mitchell

Pradeep F. Thomas

Abed M. Zaitoun

Adam J. Brooks

Professor of Gastrointestinal Surgery



To investigate the range of pathologies treated by pancreas preserving distal duodenectomy (PPDD) and present the outcome of follow-up.


Neoplastic lesions of the duodenum are treated conventionally by pancreaticoduodenectomy. Lesions distal to the major papilla may be suitable for a pancreas-preserving distal duodenectomy, potentially reducing morbidity and mortality. We present our experience with this procedure. Selective intraoperative duodenoscopy assessed the relationship of the papilla to the lesion. After duodenal mobilisation and confirmation of the site of the lesion, the duodenum was transected distal to the papilla and beyond the duodenojejunal flexure and a side-to-side duodenojejunal anastomosis was formed. Patients were identified from a prospectively maintained database and outcomes determined from digital health records with a dataset including demographics, co-morbidities, mode of presentation, preoperative imaging and assessment, nutritional support needs, technical operative details, blood transfusion requirements, length of stay, pathology including lymph node yield and lymph node involvement, length of follow-up, complications and outcomes. Related published literature was also reviewed.


Twenty-four patients had surgery with the intent of performing PPDD from 2003 to 2016. Nineteen underwent PPDD successfully. Two patients planned for PPDD proceeded to formal pancreaticoduodenectomy (PD) while three had unresectable disease. Median post-operative follow-up was 32 mo. Pathologies resected included duodenal adenocarcinoma (n = 6), adenomas (n = 5), gastrointestinal stromal tumours (n = 4) and lipoma, bleeding duodenal diverticulum, locally advanced colonic adenocarcinoma and extrinsic compression (n = 1 each). Median postoperative length of stay (LOS) was 8 d and morbidity was low [pain and nausea/vomiting (n = 2), anastomotic stricture (n = 1), pneumonia (n = 1), and overwhelming postsplenectomy sepsis (n = 1, asplenic patient)]. PPDD was associated with a significantly shorter LOS than a contemporaneous PD series [PPDD 8 (6-14) d vs PD 11 (10-16) d, median (IQR), P = 0.026]. The 30-d mortality was zero and 16 of 19 patients are alive to date. One patient died of recurrent duodenal adenocarcinoma 18 mo postoperatively and two died of unrelated disease (at 2 mo and at 8 years respectively).


PPDD is a versatile operation that can provide definitive treatment for a range of duodenal pathologies including adenocarcinoma.


Mitchell, W. K., Thomas, P. F., Zaitoun, A. M., Brooks, A. J., & Lobo, D. N. (in press). Pancreas preserving distal duodenectomy: a versatile operation for a range of infra-papillary pathologies. World Journal of Gastroenterology, 23(23),

Journal Article Type Article
Acceptance Date May 19, 2017
Online Publication Date Jun 21, 2017
Deposit Date Feb 21, 2018
Publicly Available Date Feb 21, 2018
Journal World Journal of Gastroenterology
Print ISSN 1007-9327
Electronic ISSN 2219-2840
Publisher Baishideng Publishing Group
Peer Reviewed Peer Reviewed
Volume 23
Issue 23
Keywords Pancreas preserving distal duodenectomy;
Duodenojejunostomy; Duodenal disease; Surgical
technique; Adults; Indications; Treatment; Outcome
Public URL
Publisher URL


2017_PPDD - World Journal of Gastroenterology.pdf (4 Mb)

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