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.	谢彬, 王槐志. 保留十二指肠胰头切除术的手术要点及适应症把握. 肝胆外科杂志, 2014, 22(1): 5-7.
4.	屈振, 江勇, 吴宝强, 等. 肿块型胰头良性病变38例诊治体会. 肝胆胰外科杂志, 2011, 23(2): 132-134.
5.	单毅. 胰腺头颈部良性及低度恶性肿瘤的外科处理及“功能保全, 损伤控制”理念. 实用肿瘤杂志, 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.	张生, 刘开睿, 钟小生, 等. 全腹腔镜保留十二指肠胰头切除术治疗胰头黏液囊性肿瘤. 中华腔镜外科杂志(电子版), 2018, 11(6): 374-376.
8.	陈智猛, 孙瑞, 赖魁元, 等. 腹腔镜保留十二指肠胰头切除术单中心初步经验: 附10例报告. 中国普通外科杂志, 2024, 33(3): 448-455.
9.	孙浦, 徐寅凯, 何骏, 等. 保留十二指肠胰头全切除术11例临床分析. 肝胆胰外科杂志, 2024, 36(2): 75-80.
10.	阮一, 成功, 王逻逻, 等. 完全腹腔镜下保留十二指肠胰头全切除术4例临床分析. 现代实用医学, 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, 赵刚. 十二指肠胰头切除术的适应证选择与手术策略. 中华普外科手术学杂志 (电子版), 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. 胰头部良性和低恶性病变手术治疗的器官保留与损伤控制. 中国实用外科杂志, 2009, 29(8): 622-624.
17.	杨永君, 向吉锋, 王槐志. 保留十二指肠、胆总管、Oddi’s括约肌的胰头整块全切除术 (王氏手术) 的手术要点及应用. 中国普外基础与临床杂志, 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.	张帅, 费发珠, 韩欣, 等. 三维CT重建联合吲哚菁绿显影技术应用于腹腔镜保留十二指肠胰头切除术2例报道. 中国普外基础与临床杂志, 2024, 31(7): 870-873.
20.	腹腔镜胰肠吻合技术. 中国实用外科杂志, 2022, 42(5): 539-549.
21.	白雪莉, 陈伟, 梁廷波. 中国腹腔镜胰十二指肠切除术20年胰肠重建术式变迁与未来发展. 中华普外科手术学杂志(电子版), 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.	武强, 韩濡郁, 陈璐, 等. 胰管内外引流对胰十二指肠切除术后胰瘘影响的前瞻性比较研究. 中国实用外科杂志, 2023, 43(11): 1272-1278.
26.	徐林伟, 蔡云强, 高松, 等. 胰十二指肠切除术后不同预防引流方案对结局的影响: 一项回顾性多中心真实世界研究. 中国实用外科杂志, 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. 腹腔镜保留十二指肠胰头切除术的临床应用与进展. 腹腔镜外科杂志, 2023, 28(4): 312-315.
29.	高存彬, 魏晓平, 何俊, 等. 吲哚菁绿荧光显像技术在腹腔镜复杂胆道术中胆道识别的作用. 中国临床研究, 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.	杨永君, 郭诗翔, 王槐志. 胰腺癌多学科综合治疗体会与思考. 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. 谢彬, 王槐志. 保留十二指肠胰头切除术的手术要点及适应症把握. 肝胆外科杂志, 2014, 22(1): 5-7.
4. 屈振, 江勇, 吴宝强, 等. 肿块型胰头良性病变38例诊治体会. 肝胆胰外科杂志, 2011, 23(2): 132-134.
5. 单毅. 胰腺头颈部良性及低度恶性肿瘤的外科处理及“功能保全, 损伤控制”理念. 实用肿瘤杂志, 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. 张生, 刘开睿, 钟小生, 等. 全腹腔镜保留十二指肠胰头切除术治疗胰头黏液囊性肿瘤. 中华腔镜外科杂志(电子版), 2018, 11(6): 374-376.
8. 陈智猛, 孙瑞, 赖魁元, 等. 腹腔镜保留十二指肠胰头切除术单中心初步经验: 附10例报告. 中国普通外科杂志, 2024, 33(3): 448-455.
9. 孙浦, 徐寅凯, 何骏, 等. 保留十二指肠胰头全切除术11例临床分析. 肝胆胰外科杂志, 2024, 36(2): 75-80.
10. 阮一, 成功, 王逻逻, 等. 完全腹腔镜下保留十二指肠胰头全切除术4例临床分析. 现代实用医学, 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, 赵刚. 十二指肠胰头切除术的适应证选择与手术策略. 中华普外科手术学杂志 (电子版), 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. 胰头部良性和低恶性病变手术治疗的器官保留与损伤控制. 中国实用外科杂志, 2009, 29(8): 622-624.
17. 杨永君, 向吉锋, 王槐志. 保留十二指肠、胆总管、Oddi’s括约肌的胰头整块全切除术 (王氏手术) 的手术要点及应用. 中国普外基础与临床杂志, 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. 张帅, 费发珠, 韩欣, 等. 三维CT重建联合吲哚菁绿显影技术应用于腹腔镜保留十二指肠胰头切除术2例报道. 中国普外基础与临床杂志, 2024, 31(7): 870-873.
20. 腹腔镜胰肠吻合技术. 中国实用外科杂志, 2022, 42(5): 539-549.
21. 白雪莉, 陈伟, 梁廷波. 中国腹腔镜胰十二指肠切除术20年胰肠重建术式变迁与未来发展. 中华普外科手术学杂志(电子版), 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. 武强, 韩濡郁, 陈璐, 等. 胰管内外引流对胰十二指肠切除术后胰瘘影响的前瞻性比较研究. 中国实用外科杂志, 2023, 43(11): 1272-1278.
26. 徐林伟, 蔡云强, 高松, 等. 胰十二指肠切除术后不同预防引流方案对结局的影响: 一项回顾性多中心真实世界研究. 中国实用外科杂志, 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. 腹腔镜保留十二指肠胰头切除术的临床应用与进展. 腹腔镜外科杂志, 2023, 28(4): 312-315.
29. 高存彬, 魏晓平, 何俊, 等. 吲哚菁绿荧光显像技术在腹腔镜复杂胆道术中胆道识别的作用. 中国临床研究, 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. 杨永君, 郭诗翔, 王槐志. 胰腺癌多学科综合治疗体会与思考. 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

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