Modern techniques for operation for chronic pancreatitis and pancreatic carcinoma and postoperative consequences

Partial duodenopancreatectomy was introduced into clinical surgery by Kausch [1] who, between 1909 and 1912, successfully performed a partial resection of duodenum and head of the pancreas in three patients with periampullary cancer. Currently, duodenopancreatectomy for malignant lesions is performed according to oncologic principles of surgical treatment, including wide excision of the cancer lesion, lymph dissection, and peritumorous tissue clearance. However, in benign lesions of the periampullary region the application of pancreatoduodenectomy tends to be a limited excision of the lesion to avoid any removal of histologically and functionally normal tissue. To avoid major surgical resection in benign lesions, several modifications of pancreatoduodenectomy have been developed. The pylorus-preserving pancreatic head resection was introduced in 1944 by Watson [2]; the duodenum-preserving pancreatic head resection for a benign inflammatory mass in the head of the pancreas in chronic pancreatitis was introduced in 1972 by Beger et al. [3]. Ampullectomy, which results in a complete excision of the ampulla of Vater, is a local excision of the wall of the duodenum with some parts of the head of the pancreas including the ampullary segment of the common bile duct and the confluence segment of the main pancreatic duct. A segmental resection of the periampullary duodenum offers the opportunity of resection of the head of the pancreas with conservation of 80% of the duodenum. In benign diseases of the periampullary region, the application of oncologic principles of surgery must be avoided (table 1).