Palanisamy Senthilnathan, Anand Vijai, V P Nalankilli, G Srivatsan, Sandeep Sabnis, Dilip Gode, R Parthasarathi, S Rajapandian, P Praveen Raj, C Palanivelu. GEM Hospital & Research Centre
Background: Adequate surgical resection for GIST arising in the second portion of duodenum remains challenging. It grows expansively and rarely give rise to lymph node metastase. Pancreatoduodenectomy which has been used to treat about 40% of the reported duodenal GISTs, may be an excessive means of treating this disease.
Patient details: 69 years old female presented with complaints of malena for 3 months, for which multiple transfusions were done & diagnosed to have tumor arising from second part of duodenum. Endoscopic ultrasound done showed 3cm sized tumor arising longitudinally from the second part of medial wall of duodenum away from ampulla. We planned for laparoscopic pancreas preserving duodenectomy in this situation.
Technique: Patient was placed in leg split position and surgeon stands between the legs. Gastrocolic omentum was opened and Kocherization of duodenum done. Pancreas was separated from duodenum by meticulous dissection. Endo GIA stapler was applied between D1 & D2 Junction & another one between D2 & D3 junction. Duodenum was removed from pancreas after preserving major papilla. Isolated jejunal limb was anastomosed to ampulla. Duodenojejunostomy & Jejunojejunostomy were completed.
Conclusion: Laproscopic pancreas preserving duodenectomy though technically challenging, can be an option in select cases when the expertise to perform this complicated procedure is available.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80837
Program Number: V019
Presentation Session: HPB
Presentation Type: Video