Transduodenal Surgical Ampullectomy: technical considerations

Abstract

The therapeutic approaches of ampullary tumours can be both surgical and endoscopic. Surgical options include transduodenal surgical ampullectomy, first described by Halsted in 1899 and the more radical pancreaticoduodenectomy introduced by Whipple in 1935. The endoscopic ampullectomy (papillectomy) is globally recognized as the first-line procedure for benign lesions. If endoscopic resection is not feasible and safe, a surgical approach has to be considered. Surgical treatment guarantees complete removal of the lesion nevertheless, it is burdened with a mortality rate of about 3% and high morbidity (around 20–40%) even in high-volume centers. For this reason in selected cases, the local excision technique seems to be an effective and less invasive alternative to more extensive surgery (pancreaticoduodenectomy) with consequent advantages in terms of lower morbidity and mortality. A pre-operative planning in a multidisciplinary board is mandatory prior to the procedure. Given that it remains a challenging procedure that requires particular surgical experience and operative skills offering good results in terms of morbidity and mortality and should be in the armamentarium of every pancreatic surgeon. The aim of this short research article is to offer to the lecturer a comprehensive view about the transduodenal ampullectomy in the treatment of localized ampullary diseases.