[Ampullectomy in benign lesion: indications and results].
BACKGROUND
Surgical resection remains today the standard treatment of ampullary and papilla tumours. Whether pancreaticoduodenectomy (PD) or ampullectomy is indicated for presumed benign lesions remains debated. The feared potential post-operative morbidity of ampullectomies is balanced by the functional sequelae of PD.


OBJECTIVE
This work reports our experience of ampullectomies for presumed benign lesion of the ampulla and papilla and analyses the indications and results of ampullectomies, considering both our series and published series of the literature.


METHODS
Since 1997, eight ampullectomies with frozen section have been performed for presumed benign lesions, taking account of morphologic criteria and pre-operative endoscopic biopsies.


RESULTS
Post-operative mortality was nil. Post-operative morbidity included one bilio-enteric fistula and four acute pancreatitis, all treated conservatively. Final pathological examination showed one benign and one malignant ampullomas, one benign fibrous stenosis of the papilla, one duodenal duplication and one choledococele, two adenomas and one adenomyomatosis of the papilla in patients with familial adenomatous polyposis (FAP). During follow-up, one de novo duodenal adenoma in FAP and one benign stenosis of the papilla were observed and treated endoscopically. All other patients remain asymptomatic.


CONCLUSIONS
Ampullectomy with accurate intra-operative frozen section appears adequate for presumed benign lesion of the papilla and ampulla.
Miossec
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Centre de chirurgie digestive de l'hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
Parc
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Paye
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D000236:Adenoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D011125:Adenomatous Polyposis Coli / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000002:abnormalities / Q000473:pathology / Q000601:surgery*; D001706:Biopsy; D003137:Common Bile Duct Diseases / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D005629:Frozen Sections; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors