Pancreatic Head Excavation: A Variation on the Theme of Duodenum-Preserving Pancreatic Head Resection

Hypothesis: Despite the introduction of new methods for duodenum-preserving pancreatic head resection, such as the Beger and Frey procedures, the management of benign lesions of the proximal pancreas remains controversial. We developed a modification of the duodenum-preserving pancreatic head resection in which the proximal pancreatic duct or central core of the pancreatic head is excised by ultrasonic dissection and examined the feasibility, safety, and outcomes of this new procedure. Design and Setting: Prospective cohort study in an academic tertiary care referral center. Patients: From April 1, 2001, to September 8, 2003, 6 patients with either chronic pancreatitis (4) or benign tumors of the pancreatic head (2) underwent ultrasonic excavation of the pancreatic head, with reconstruction by a single longitudinal, Roux-en-Y pancreaticojejunostomy. Main Outcome Measures: Safety and cost were assessed by measures of operative time, blood loss, nasogastric drainage, and length of stay. Any complications and the degree of full functional recovery were noted. Results: The technique of ultrasonic excavation of the central pancreatic head is reviewed in detail. Operative time ranged from 344 to 427 minutes (average, 390 minutes); blood loss ranged from 200 to 1300 mL (average, 475 mL); nasogastric drainage ranged from 3 to 5 days; and length of stay ranged from 6 to 8 days. No major complications occurred. Two patients had transient, probable drug-related ileus after discharge. All patients had full functional recovery. Conclusions: Our modification of the technique of duodenum-preserving pancreatic head resection using ultrasonic dissection and longitudinal reconstruction appears feasible, safe, and effective for benign disease of the proximal pancreas.