title: Surgical ampullectomy: an underestimated operation in the era of endoscopy.
abstract: BACKGROUND
  Benign neoplastic, inflammatory or functional pathologies of the ampulla of Vater are mainly treated by primary endoscopic interventions. Consequently, transduodenal surgical ampullectomy (TSA) has been abandoned in many centres, although it represents an important tool not only after unsuccessful endoscopic treatment. The aim of the study was to analyse TSA for benign lesions of the ampulla of Vater.
  
  
  METHODS
  All patients who underwent TSA between 2001 and 2014 were included. Patients were analysed in terms of indications, postoperative morbidity and mortality as well as long-term success.
  
  
  RESULTS
  Eighty-three patients underwent TSA. Indications included adenomas in 44 and inflammatory stenosis in 39 patients. 96% of the patients had undergone endoscopic therapeutic approaches prior to TSA (median no. of interventions n = 3). Postoperative morbidity occurred in 20 patients (24%). There was one procedure-associated death (mortality 1.2%). The mean follow-up was 54 months. Long-term overall success rate for TSA was 83.6%. After TSA for ampullary adenoma, the recurrence rate was 4.5%.
  
  
  CONCLUSIONS
  TSA is an underestimated surgical procedure, which can be performed safely with high long-term efficacy. It can be implemented in clinical algorithms for patients with benign pathologies of the ampulla of Vater, particularly after unsuccessful endoscopic treatment.
authors.affiliation: Department for General, Visceral and Transplantation Surgery, University of Heidelberg, Germany. Electronic address: Markus.Buechler@med.uni-heidelberg.de.
authors.forename: Lutz
authors.initials: L
authors.lastname: Schneider
authors.affiliation: Department for General, Visceral and Transplantation Surgery, University of Heidelberg, Germany.
authors.forename: Pietro
authors.initials: P
authors.lastname: Contin
authors.affiliation: Department for General, Visceral and Transplantation Surgery, University of Heidelberg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Fritz
authors.affiliation: Department for General, Visceral and Transplantation Surgery, University of Heidelberg, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Strobel
authors.affiliation: Department for General, Visceral and Transplantation Surgery, University of Heidelberg, Germany.
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.affiliation: Department for General, Visceral and Transplantation Surgery, University of Heidelberg, Germany.
authors.forename: Thilo
authors.initials: T
authors.lastname: Hackert
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000368:Aged; D014670:Ampulla of Vater / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002779:Cholestasis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016208:Databases, Factual; D004724:Endoscopy; D005240:Feasibility Studies; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010180:Pancreatectomy; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome