Laparoscopic Partial Sleeve Duodenectomy for Gastrinoma

Ruchir Puri, MD, John A Stauffer, MD, FACS, Horacio J Asbun, MD, FACS. Mayo Clinic, Florida.

The video submission is a case presentation of a 55 y M who was found to have a gastrinoma in the third portion of the duodenum. He also had a more distal lesion concerning for multifocality. He underwent a laparoscopic partial sleeve duodenectomy (PSD) for the same. The video highlights technical considerations and steps of a laparoscopic PSD. Key steps in this procedure which make it difficult are the exposure of the duodenum as it passes underneath the root of the mesentery and separation of the 3rd and 4th portion of the duodenum from the uncinate process and the head of the pancreas. Laparoscopic PSD spares resection of the head of the pancreas by separating the duodenum from the head of the pancreas under direct magnified vision. Intraoperative cholangiogram was performed to ensure patency of the ampulla prior to transection of the duodenum just distal to the ampulla. Reconstruction was performed using a side to side duodenojejunostomy. The patient was found to have a 0.7 cm gastrinoma, the distal lesion was found to be benign. His post operative recovery was uneventful.

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