Laparoscopic Transduodenal Ampullectomy of Mixed Ampullary Polyp

Robert Sung, MD, Diana J McPhee, MD, Paresh C Shah, MD

North Shore LIJ – Lenox Hill Hospital

Laparoscopic transduodenal ampullectomy is an uncommon procedure for ampullary neoplasm. We present the case of a 65 year old male with transient obstructive jaundice, nausea and vomiting with a 60 pound weight loss over 4 months. Endoscopy identified a large pedunculated polyp involving the ampulla with extension into the distal duodenum secondary to intussusception. Biospies were consistent with tubulovillous adenoma without invasion. Computed tomography demonstrated no mass effect, a normal pancreatic duct and a dilated common bile duct. In this video we demonstrate our technique for a laparoscopic transduodenal ampullectomy via a longitudinal duodenotomy with reimplantation of the bile duct and transverse duodenal closure. Intra-operative frozen section analysis showed no evidence of invasive cancer. The patient had an uneventful recovery. A gastrograffin upper GI series was performed on post-operative day 5, a liquid diet was commenced and he was discharged the following day. The final pathology showed a mixed adenomatous and hamartomatous polyp surrounded by unremarkable small intestinal mucosa, margins were negative for adenoma.

Session: Video Channel Day 1

Program Number: V064

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