Clinical review and analysis of laparoscopic duodenum-preserving pancreatic head resection for 12 cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

DAI Longao ¹ ,  WEI Dong ¹ ,  TANG Bo ¹ , ZOU Renchao ¹ , WANG Qiuhong ¹ , WANG Huaizhi ²

1. Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming 650000, P. R. China;
2. Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing University, Chongqing 401147, P. R. China;

Corresponding?author：

WEI Dong, Email: weidong@kmmu.edu.cn; TANG Bo, Email: tangbo1227@163.com

Keywords：

laparoscopic duodenum-preserving pancreatic head resection; clinical effect; postoperative pancreatic fistula

DOI：

10.7507/1007-9424.202501025

Video：

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Objective To evaluate and synthesize the available experiences related to laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) in the management of benign pancreatic head lesions. Methods A retrospective review of the clinical data was conducted for 12 patients who underwent LDPPHR at the Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Kunming Medical University (between January 2020 and December 2024). Results All 12 patients successfully underwent LDPPHR. The surgical duration ranged from 138 to 479 min, with a mean of 336 min. Intraoperative blood loss varied between 40 and 700 mL, averaging 270 mL. The hospital stay varied from 11 to 51 d, with a mean duration of 21.5 d. Notably, none of the 12 patients required blood transfusions during the procedure. Of the 12 patients, 6 were diagnosed with a pancreatic fistula postoperatively, including 5 cases classified as grade A pancreatic fistula, and 1 cases of grade B pancreatic leakage. There were 2 cases of bile leakage and 1 case of gastric emptying disorder. No deaths occurred during the perioperative period. Postoperative pathological examination revealed: chronic pancreatitis witch main pancreatic duct stones in 8 cases, intraductal papillary mucinous neoplasms with low-grade epithelial intraepithelial neoplasia in 3 cases, serous cystadenoma in 1 case. Postoperative follow-up was conducted for 10 patients, with follow-up durations ranging from 6 to 24 months. No recurrence was observed during the follow-up period, and no long-term complications such as diabetes, gastric emptying dysfunction, etc. were reported. Conclusions LDPPHR offers several benefits, including minimal invasiveness, faster recovery, and enhanced postoperative quality of life for patients. It is safe and feasible for the treatment of benign lesions in the head of the pancreas.

Citation： DAI Longao, WEI Dong, TANG Bo, ZOU Renchao, WANG Qiuhong, WANG Huaizhi. Clinical review and analysis of laparoscopic duodenum-preserving pancreatic head resection for 12 cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(2): 169-174. doi: 10.7507/1007-9424.202501025 Copy

1.	Beger HG, Friess H, Uhl W. Whipple resection for benign tumors and premalignant neoplasms of the pancreatic head: surgery-associated risk for complications and late metabolic morbidity matters. Ann Surg Open, 2023, 4(3): e325. doi: 10.1097/AS9.0000000000000325.
2.	Beger HG, Büchler M, Bittner RR, et al. Duodenum-preserving resection of the head of the pancreas in severe chronic pancreatitis. Early and late results. Ann Surg, 1989, 209(3): 273-278.
3.	謝彬, 王槐志. 保留十二指腸胰頭切除術的手術要點及適應癥把握. 肝膽外科雜志, 2014, 22(1): 5-7.
4.	屈振, 江勇, 吳寶強, 等. 腫塊型胰頭良性病變38例診治體會. 肝膽胰外科雜志, 2011, 23(2): 132-134.
5.	單毅. 胰腺頭頸部良性及低度惡性腫瘤的外科處理及“功能保全, 損傷控制”理念. 實用腫瘤雜志, 2011, 26(2): 102-106.
6.	Zhou J, Zhou Y, Mou Y, et al. Laparoscopic duodenum-preserving pancreatic head resection: a case report. Medicine (Baltimore), 2016, 95(32): e4442. doi: 10.1097/MD.0000000000004442.
7.	張生, 劉開睿, 鐘小生, 等. 全腹腔鏡保留十二指腸胰頭切除術治療胰頭黏液囊性腫瘤. 中華腔鏡外科雜志(電子版), 2018, 11(6): 374-376.
8.	陳智猛, 孫瑞, 賴魁元, 等. 腹腔鏡保留十二指腸胰頭切除術單中心初步經驗: 附10例報告. 中國普通外科雜志, 2024, 33(3): 448-455.
9.	孫浦, 徐寅凱, 何駿, 等. 保留十二指腸胰頭全切除術11例臨床分析. 肝膽胰外科雜志, 2024, 36(2): 75-80.
10.	阮一, 成功, 王邏邏, 等. 完全腹腔鏡下保留十二指腸胰頭全切除術4例臨床分析. 現代實用醫學, 2023, 35(1): 31-35.
11.	Kondo Y, Friess H, Tempia-Caliera AA, et al. Duodenum-preserving pancreatic head resection: future standard operation in chronic pancreatitis. Swiss Surg, 2000, 6(5): 254-258.
12.	Beger HG, Mayer B, Poch B. Duodenum-preserving pancreatic head resection for benign and premalignant tumors-a systematic review and meta-analysis of surgery-associated morbidity. J Gastrointest Surg, 2023, 27(11): 2611-2627.
13.	Beger HG, Mayer B, Rau BM. Parenchyma-sparing, limited pancreatic head resection for benign tumors and low-risk periampullary cancer–a systematic review. J Gastrointest Surg, 2016, 20(1): 206-217.
14.	王春友, 趙剛. 十二指腸胰頭切除術的適應證選擇與手術策略. 中華普外科手術學雜志 (電子版), 2013, 7(3): 176-178.
15.	Cao J, Li GL, Wei JX, et al. Laparoscopic duodenum-preserving total pancreatic head resection: a novel surgical approach for benign or low-grade malignant tumors. Surg Endosc, 2019, 33(2): 633-638.
16.	王春友. 胰頭部良性和低惡性病變手術治療的器官保留與損傷控制. 中國實用外科雜志, 2009, 29(8): 622-624.
17.	楊永君, 向吉鋒, 王槐志. 保留十二指腸、膽總管、Oddi’s括約肌的胰頭整塊全切除術 (王氏手術) 的手術要點及應用. 中國普外基礎與臨床雜志, 2025, 32(2): 143-147.
18.	Beger HG, Nakao A, Mayer B, et al. Duodenum-preserving total and partial pancreatic head resection for benign tumors–systematic review and meta-analysis. Pancreatology, 2015, 15(2): 167-178.
19.	張帥, 費發珠, 韓欣, 等. 三維CT重建聯合吲哚菁綠顯影技術應用于腹腔鏡保留十二指腸胰頭切除術2例報道. 中國普外基礎與臨床雜志, 2024, 31(7): 870-873.
20.	腹腔鏡胰腸吻合技術. 中國實用外科雜志, 2022, 42(5): 539-549.
21.	白雪莉, 陳偉, 梁廷波. 中國腹腔鏡胰十二指腸切除術20年胰腸重建術式變遷與未來發展. 中華普外科手術學雜志(電子版), 2021, 15(3): 250-254.
22.	Motoi F, Egawa S, Rikiyama T, et al. Randomized clinical trial of external stent drainage of the pancreatic duct to reduce postoperative pancreatic fistula after pancreaticojejunostomy. Br J Surg, 2012, 99(4): 524-531.
23.	Smyrniotis V, Arkadopoulos N, Kyriazi MA, et al. Does internal stenting of the pancreaticojejunostomy improve outcomes after pancreatoduodenectomy? A prospective study. Langenbecks Arch Surg, 2010, 395(3): 195-200.
24.	Cai Y, Luo H, Li Y, et al. A novel technique of pancreaticojejunostomy for laparoscopic pancreatico- duodenectomy. Surg Endosc, 2019, 33(5): 1572-1577.
25.	武強, 韓濡郁, 陳璐, 等. 胰管內外引流對胰十二指腸切除術后胰瘺影響的前瞻性比較研究. 中國實用外科雜志, 2023, 43(11): 1272-1278.
26.	徐林偉, 蔡云強, 高松, 等. 胰十二指腸切除術后不同預防引流方案對結局的影響: 一項回顧性多中心真實世界研究. 中國實用外科雜志, 2024, 44(4): 441-446.
27.	Abete M, Ronchetti V, Casano A, et al. La fistola pancreatica dopo duodenocefalopancreasectomia: fattori di rischio e principi di trattamento [Pancreatic fistula after pancreaticoduodenectomy: risk factors and treatment]. Minerva Chir, 2005, 60(2): 99-110.
28.	冀旭, 熊光冰, 袁天, 等. 腹腔鏡保留十二指腸胰頭切除術的臨床應用與進展. 腹腔鏡外科雜志, 2023, 28(4): 312-315.
29.	高存彬, 魏曉平, 何俊, 等. 吲哚菁綠熒光顯像技術在腹腔鏡復雜膽道術中膽道識別的作用. 中國臨床研究, 2023, 36(8): 1138-1142.
30.	Zach S, Wilhelm TJ, Rückert F, et al. Redo surgery after duodenum-preserving pancreatic head resection for chronic pancreatitis: high incidence in long-term follow-up. J Gastrointest Surg, 2015, 19(6): 1078-1085.
31.	Beger HG, Kunz R, Poch B. The Beger procedure–duodenum-preserving pancreatic head resection. J Gastrointest Surg, 2004, 8(8): 1090-1097.
32.	楊永君, 郭詩翔, 王槐志. 胰腺癌多學科綜合治療體會與思考. 腹部外科, 2022, 35(5): 305-308.

1. Beger HG, Friess H, Uhl W. Whipple resection for benign tumors and premalignant neoplasms of the pancreatic head: surgery-associated risk for complications and late metabolic morbidity matters. Ann Surg Open, 2023, 4(3): e325. doi: 10.1097/AS9.0000000000000325.
2. Beger HG, Büchler M, Bittner RR, et al. Duodenum-preserving resection of the head of the pancreas in severe chronic pancreatitis. Early and late results. Ann Surg, 1989, 209(3): 273-278.
3. 謝彬, 王槐志. 保留十二指腸胰頭切除術的手術要點及適應癥把握. 肝膽外科雜志, 2014, 22(1): 5-7.
4. 屈振, 江勇, 吳寶強, 等. 腫塊型胰頭良性病變38例診治體會. 肝膽胰外科雜志, 2011, 23(2): 132-134.
5. 單毅. 胰腺頭頸部良性及低度惡性腫瘤的外科處理及“功能保全, 損傷控制”理念. 實用腫瘤雜志, 2011, 26(2): 102-106.
6. Zhou J, Zhou Y, Mou Y, et al. Laparoscopic duodenum-preserving pancreatic head resection: a case report. Medicine (Baltimore), 2016, 95(32): e4442. doi: 10.1097/MD.0000000000004442.
7. 張生, 劉開睿, 鐘小生, 等. 全腹腔鏡保留十二指腸胰頭切除術治療胰頭黏液囊性腫瘤. 中華腔鏡外科雜志(電子版), 2018, 11(6): 374-376.
8. 陳智猛, 孫瑞, 賴魁元, 等. 腹腔鏡保留十二指腸胰頭切除術單中心初步經驗: 附10例報告. 中國普通外科雜志, 2024, 33(3): 448-455.
9. 孫浦, 徐寅凱, 何駿, 等. 保留十二指腸胰頭全切除術11例臨床分析. 肝膽胰外科雜志, 2024, 36(2): 75-80.
10. 阮一, 成功, 王邏邏, 等. 完全腹腔鏡下保留十二指腸胰頭全切除術4例臨床分析. 現代實用醫學, 2023, 35(1): 31-35.
11. Kondo Y, Friess H, Tempia-Caliera AA, et al. Duodenum-preserving pancreatic head resection: future standard operation in chronic pancreatitis. Swiss Surg, 2000, 6(5): 254-258.
12. Beger HG, Mayer B, Poch B. Duodenum-preserving pancreatic head resection for benign and premalignant tumors-a systematic review and meta-analysis of surgery-associated morbidity. J Gastrointest Surg, 2023, 27(11): 2611-2627.
13. Beger HG, Mayer B, Rau BM. Parenchyma-sparing, limited pancreatic head resection for benign tumors and low-risk periampullary cancer–a systematic review. J Gastrointest Surg, 2016, 20(1): 206-217.
14. 王春友, 趙剛. 十二指腸胰頭切除術的適應證選擇與手術策略. 中華普外科手術學雜志 (電子版), 2013, 7(3): 176-178.
15. Cao J, Li GL, Wei JX, et al. Laparoscopic duodenum-preserving total pancreatic head resection: a novel surgical approach for benign or low-grade malignant tumors. Surg Endosc, 2019, 33(2): 633-638.
16. 王春友. 胰頭部良性和低惡性病變手術治療的器官保留與損傷控制. 中國實用外科雜志, 2009, 29(8): 622-624.
17. 楊永君, 向吉鋒, 王槐志. 保留十二指腸、膽總管、Oddi’s括約肌的胰頭整塊全切除術 (王氏手術) 的手術要點及應用. 中國普外基礎與臨床雜志, 2025, 32(2): 143-147.
18. Beger HG, Nakao A, Mayer B, et al. Duodenum-preserving total and partial pancreatic head resection for benign tumors–systematic review and meta-analysis. Pancreatology, 2015, 15(2): 167-178.
19. 張帥, 費發珠, 韓欣, 等. 三維CT重建聯合吲哚菁綠顯影技術應用于腹腔鏡保留十二指腸胰頭切除術2例報道. 中國普外基礎與臨床雜志, 2024, 31(7): 870-873.
20. 腹腔鏡胰腸吻合技術. 中國實用外科雜志, 2022, 42(5): 539-549.
21. 白雪莉, 陳偉, 梁廷波. 中國腹腔鏡胰十二指腸切除術20年胰腸重建術式變遷與未來發展. 中華普外科手術學雜志(電子版), 2021, 15(3): 250-254.
22. Motoi F, Egawa S, Rikiyama T, et al. Randomized clinical trial of external stent drainage of the pancreatic duct to reduce postoperative pancreatic fistula after pancreaticojejunostomy. Br J Surg, 2012, 99(4): 524-531.
23. Smyrniotis V, Arkadopoulos N, Kyriazi MA, et al. Does internal stenting of the pancreaticojejunostomy improve outcomes after pancreatoduodenectomy? A prospective study. Langenbecks Arch Surg, 2010, 395(3): 195-200.
24. Cai Y, Luo H, Li Y, et al. A novel technique of pancreaticojejunostomy for laparoscopic pancreatico- duodenectomy. Surg Endosc, 2019, 33(5): 1572-1577.
25. 武強, 韓濡郁, 陳璐, 等. 胰管內外引流對胰十二指腸切除術后胰瘺影響的前瞻性比較研究. 中國實用外科雜志, 2023, 43(11): 1272-1278.
26. 徐林偉, 蔡云強, 高松, 等. 胰十二指腸切除術后不同預防引流方案對結局的影響: 一項回顧性多中心真實世界研究. 中國實用外科雜志, 2024, 44(4): 441-446.
27. Abete M, Ronchetti V, Casano A, et al. La fistola pancreatica dopo duodenocefalopancreasectomia: fattori di rischio e principi di trattamento [Pancreatic fistula after pancreaticoduodenectomy: risk factors and treatment]. Minerva Chir, 2005, 60(2): 99-110.
28. 冀旭, 熊光冰, 袁天, 等. 腹腔鏡保留十二指腸胰頭切除術的臨床應用與進展. 腹腔鏡外科雜志, 2023, 28(4): 312-315.
29. 高存彬, 魏曉平, 何俊, 等. 吲哚菁綠熒光顯像技術在腹腔鏡復雜膽道術中膽道識別的作用. 中國臨床研究, 2023, 36(8): 1138-1142.
30. Zach S, Wilhelm TJ, Rückert F, et al. Redo surgery after duodenum-preserving pancreatic head resection for chronic pancreatitis: high incidence in long-term follow-up. J Gastrointest Surg, 2015, 19(6): 1078-1085.
31. Beger HG, Kunz R, Poch B. The Beger procedure–duodenum-preserving pancreatic head resection. J Gastrointest Surg, 2004, 8(8): 1090-1097.
32. 楊永君, 郭詩翔, 王槐志. 胰腺癌多學科綜合治療體會與思考. 腹部外科, 2022, 35(5): 305-308.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical review and analysis of laparoscopic duodenum-preserving pancreatic head resection for 12 cases

Abstract Full text Figures/Tables Video References Cited by

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