Laparoscopic transduodenal ampullectomy for benign ampullary tumors.
BACKGROUND
Transduodenal ampullectomy (TDA) can be performed for benign and premalignant tumors of the ampulla of Vater (AOV) as an alternative to pancreaticoduodenectomy. However, the laparoscopic approach has rarely been attempted. In this report 2 cases of benign ampullary tumor that were treated by totally laparoscopic TDA.


METHODS
Case 1 was of a 75-year-old female who was admitted with left knee pain and underwent arthroscopic debridement. On postoperative day 6, she showed elevated levels of alkaline phosphatase, aspirate aminotransferase, alanine transaminase, and gamma-glutamyl transpeptidase, without any other laboratory test abnormality. She had no complaint of abdominal pain, and physical examinations were unremarkable. Computed tomography (CT), magnetic resonance cholangiography (MRCP), and endoscopy revealed a 2-cm-sized polypoid mass at the AOV. Subsequent endoscopic biopsy showed a pathologic finding of tubular adenoma. Case 2 was of a 55-year-old man who was admitted with an duodenal mass incidentally detected by screening endoscopy in a community hospital. Abdominal CT, endoscopy, and endoscopic ultrasonography revealed a 2.5-cm-sized tumor located at the duodenal papilla with possible extension to the ampullary sphincter. Endoscopic biopsy revealed gangliocytic paraganglioma. Both patients underwent laparoscopic transduodenal ampullectomy.


RESULTS
Operative times were 200 and 250 minutes, respectively, and estimated blood loss during both operations was about 50 mL. Patients were discharged on the postoperative days 9 and 8, respectively, without any complication. Postoperative histologic examinations revealed tubular adenoma with low-grade dysplasia in 1 patient and gangliocystic paraganglioma in the other.


CONCLUSIONS
These 2 cases demonstrate that laparoscopic TDA is a feasible operative procedure in selective patients with a benign or premalignant tumor at the AOV.
Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Bundang-gu, Korea.
Keun Soo
KS
Ahn
Ho-Seong
HS
Han
Yoo-Seok
YS
Yoon
Jai Young
JY
Cho
Khasan
K
Khalikulov
D000368:Aged; D014670:Ampulla of Vater / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D004386:Duodenum; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged