Intracapsular approach used in laparoscopic duodenum-preserving total pancreatic head resection: Tongji Hospital experience_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XU Meng , QIAO Liang , YUAN Tian ,  ZHU Feng

Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, P. R. China;

Corresponding author：

ZHU Feng, Email: zfjch1977@sina.com

Keywords：

intracapsular approach used in laparoscopic duodenum-preserving total pancreatic head resection; duodenum-preserving pancreatic head resection; operation effect

DOI：

10.7507/1007-9424.202412130

Video：

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Objective To explore the clinical efficacy and summarize the experience of intracapsular approach used in laparoscopic duodenum-preserving total pancreatic head resection (LDPPHRt). Method The clinical data of patients (from April 2020 to June 2024), including preoperative, intraoperative, and postoperative details who underwent LDPPHRt in Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology were collected and analyzed. Results Seventy-five patients were collected in this study, including 35 males (46.7%) and 40 females (53.3%). The age was (38.3±7.9) years old, and 35 patients (46.7%) presented without symptoms. The main symptoms were abdominal pain (21 cases, 28.0%), repeated diarrhea (15 cases, 20.0%), weight loss (4 cases, 5.3%). The diameter of the pancreatic head lesions was (3.2±0.8) cm. The operative time was (210.6±23.8) min, and the blood loss was (62.4±38.1) mL. There were 18 cases (24.0%) of postoperative complications, including 6 cases (8.0%) of postoperative pancreatic fistula, 5 cases (6.7%) of haemorrhage, 4 cases (5.3%) of biliary leakage, 2 cases (2.7%) of lymphatic leakage, 4 cases (5.3%) of delayed gastric emptying, 2 cases (2.7%) of abdominal infection, 1 case (1.3%) of pulmonary infection and 2 cases (2.7%) of wound infection. The length of postoperative hospital stay was (11.7±3.3) d, and no one died within 90 d after surgery. Conclusions The intracapsular approach is a feasible and safe surgical procedure in LDPPHRt for patients with benign, borderline or low grade malignant tumors.

Citation： XU Meng, QIAO Liang, YUAN Tian, ZHU Feng. Intracapsular approach used in laparoscopic duodenum-preserving total pancreatic head resection: Tongji Hospital experience. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(2): 163-168. doi: 10.7507/1007-9424.202412130 Copy

1.	Beger HG, Kunz R, Poch B. The Beger procedure–duodenum-preserving pancreatic head resection. J Gastrointest Surg, 2004, 8(8): 1090-1097.
2.	Wang M, Xu S, Zhang H, et al. Imbedding pancreaticojejunostomy used in pure laparoscopic pancreaticoduodenectomy for nondilated pancreatic duct. Surg Endosc, 2017, 31(4): 1986-1992.
3.	Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis. Pancreas, 1987, 2(6): 701-707.
4.	Gloor B, Friess H, Uhl W, et al. A modified technique of the Beger and Frey procedure in patients with chronic pancreatitis. Dig Surg, 2001, 18(1): 21-25.
5.	Kempeneers MA, Issa Y, Ali UA, et al. International consensus guidelines for surgery and the timing of intervention in chronic pancreatitis. Pancreatology, 2020, 20(2): 149-157.
6.	Takada T, Yasuda H, Uchiyama K, et al. Duodenum-preserving pancreatoduodenostomy. A new technique for complete excision of the head of the pancreas with preservation of biliary and alimentary integrity. Hepatogastroenterology, 1993, 40(4): 356-359.
7.	Gockel I, Domeyer M, Wolloscheck T, et al. Resection of the mesopancreas (RMP): a new surgical classification of a known anatomical space. World J Surg Oncol, 2007, 5: 44. doi: 10.1186/1477-7819-5-44.
8.	Adham M, Singhirunnusorn J. Surgical technique and results of total mesopancreas excision (TMpE) in pancreatic tumors. Eur J Surg Oncol, 2012, 38(4): 340-345.
9.	Agrawal MK, Thakur DS, Somashekar U, et al. Mesopancreas: myth or reality? JOP, 2010, 11(3): 230-233.
10.	Bouassida M, Mighri MM, Chtourou MF, et al. Retroportal lamina or mesopancreas? Lessons learned by anatomical and histological study of thirty three cadaveric dissections. Int J Surg, 2013, 11(9): 834-836.
11.	中华医学会外科学分会胰腺外科学组. 胰腺囊性疾病诊治指南 (2015版). 临床肝胆病杂志, 2015, 31(9): 1375-1378.
12.	Pedrazzoli S, Canton SA, Sperti C. Duodenum-preserving versus pylorus-preserving pancreatic head resection for benign and premalignant lesions. J Hepatobiliary Pancreat Sci, 2011, 18(1): 94-102.
13.	Beger HG, Mayer B, Poch B. Duodenum-preserving pancreatic head resection for benign and premalignant tumors-a systematic review and meta-analysis of surgery-associated morbidity. J Gastrointest Surg, 2023, 27(11): 2611-2627.
14.	Cao J, Li GL, Wei JX, et al. Laparoscopic duodenum-preserving total pancreatic head resection: a novel surgical approach for benign or low-grade malignant tumors. Surg Endosc, 2019, 33(2): 633-638.
15.	Cai Y, Zheng Z, Gao P, et al. Laparoscopic duodenum-preserving total pancreatic head resection using real-time indocyanine green fluorescence imaging. Surg Endosc, 2021, 35(3): 1355-1361.
16.	Hong D, Cheng J, Wu W, et al. How to perform total laparoscopic duodenum-preserving pancreatic head resection safely and efficiently with innovative techniques. Ann Surg Oncol, 2021, 28(6): 3209-3216.
17.	Zhou M, Xu S, Chao D, et al. Intracapsular approach used in laparoscopic duodenum-preserving total pancreatic head resection for pancreatic head benign or low-grade malignant tumors. Langenbecks Arch Surg, 2022, 407(8): 3851-3858.
18.	Beger HG, Mayer B, Poch B. Long-term oncologic outcome following duodenum-preserving pancreatic head resection for benign tumors, cystic neoplasms, and neuroendocrine tumors: systematic review and meta-analysis. Ann Surg Oncol, 2024, 31(7): 4637-4653.
19.	Möbius C, Max D, Uhlmann D, et al. Five-year follow-up of a prospective non-randomised study comparing duodenum-preserving pancreatic head resection with classic Whipple procedure in the treatment of chronic pancreatitis. Langenbecks Arch Surg, 2007, 392(3): 359-364.
20.	Zheng Z, Xiang G, Tan C, et al. Pancreaticoduodenectomy versus duodenum-preserving pancreatic head resection for the treatment of chronic pancreatitis. Pancreas, 2012, 41(1): 147-152.
21.	Aimoto T, Uchida E, Matsushita A, et al. Long-term outcomes after Frey’s procedure for chronic pancreatitis with an inflammatory mass of the pancreatic head, with special reference to locoregional complications. J Nippon Med Sch, 2013, 80(2): 148-154.
22.	Sun YH, Ding N, Cheng K, et al. Comparative analysis of duodenum-preserving pancreatic head resection and pancreaticoduodenectomy. Chin Med J (Engl), 2020, 133(17): 2112-2113.
23.	Diener MK, Hüttner FJ, Kieser M, et al. Partial pancreatoduodenectomy versus duodenum-preserving pancreatic head resection in chronic pancreatitis: the multicentre, randomised, controlled, double-blind ChroPac trial. Lancet, 2017, 390(10099): 1027-1037.
24.	Yin T, Wen J, Zhen T, et al. Long-term quality of life between duodenum-preserving pancreatic head resection and pancreatoduodenectomy: a systematic review and meta-analysis. Int J Surg, 2024, 110(2): 1139-1148.

1. Beger HG, Kunz R, Poch B. The Beger procedure–duodenum-preserving pancreatic head resection. J Gastrointest Surg, 2004, 8(8): 1090-1097.
2. Wang M, Xu S, Zhang H, et al. Imbedding pancreaticojejunostomy used in pure laparoscopic pancreaticoduodenectomy for nondilated pancreatic duct. Surg Endosc, 2017, 31(4): 1986-1992.
3. Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis. Pancreas, 1987, 2(6): 701-707.
4. Gloor B, Friess H, Uhl W, et al. A modified technique of the Beger and Frey procedure in patients with chronic pancreatitis. Dig Surg, 2001, 18(1): 21-25.
5. Kempeneers MA, Issa Y, Ali UA, et al. International consensus guidelines for surgery and the timing of intervention in chronic pancreatitis. Pancreatology, 2020, 20(2): 149-157.
6. Takada T, Yasuda H, Uchiyama K, et al. Duodenum-preserving pancreatoduodenostomy. A new technique for complete excision of the head of the pancreas with preservation of biliary and alimentary integrity. Hepatogastroenterology, 1993, 40(4): 356-359.
7. Gockel I, Domeyer M, Wolloscheck T, et al. Resection of the mesopancreas (RMP): a new surgical classification of a known anatomical space. World J Surg Oncol, 2007, 5: 44. doi: 10.1186/1477-7819-5-44.
8. Adham M, Singhirunnusorn J. Surgical technique and results of total mesopancreas excision (TMpE) in pancreatic tumors. Eur J Surg Oncol, 2012, 38(4): 340-345.
9. Agrawal MK, Thakur DS, Somashekar U, et al. Mesopancreas: myth or reality? JOP, 2010, 11(3): 230-233.
10. Bouassida M, Mighri MM, Chtourou MF, et al. Retroportal lamina or mesopancreas? Lessons learned by anatomical and histological study of thirty three cadaveric dissections. Int J Surg, 2013, 11(9): 834-836.
11. 中华医学会外科学分会胰腺外科学组. 胰腺囊性疾病诊治指南 (2015版). 临床肝胆病杂志, 2015, 31(9): 1375-1378.
12. Pedrazzoli S, Canton SA, Sperti C. Duodenum-preserving versus pylorus-preserving pancreatic head resection for benign and premalignant lesions. J Hepatobiliary Pancreat Sci, 2011, 18(1): 94-102.
13. Beger HG, Mayer B, Poch B. Duodenum-preserving pancreatic head resection for benign and premalignant tumors-a systematic review and meta-analysis of surgery-associated morbidity. J Gastrointest Surg, 2023, 27(11): 2611-2627.
14. Cao J, Li GL, Wei JX, et al. Laparoscopic duodenum-preserving total pancreatic head resection: a novel surgical approach for benign or low-grade malignant tumors. Surg Endosc, 2019, 33(2): 633-638.
15. Cai Y, Zheng Z, Gao P, et al. Laparoscopic duodenum-preserving total pancreatic head resection using real-time indocyanine green fluorescence imaging. Surg Endosc, 2021, 35(3): 1355-1361.
16. Hong D, Cheng J, Wu W, et al. How to perform total laparoscopic duodenum-preserving pancreatic head resection safely and efficiently with innovative techniques. Ann Surg Oncol, 2021, 28(6): 3209-3216.
17. Zhou M, Xu S, Chao D, et al. Intracapsular approach used in laparoscopic duodenum-preserving total pancreatic head resection for pancreatic head benign or low-grade malignant tumors. Langenbecks Arch Surg, 2022, 407(8): 3851-3858.
18. Beger HG, Mayer B, Poch B. Long-term oncologic outcome following duodenum-preserving pancreatic head resection for benign tumors, cystic neoplasms, and neuroendocrine tumors: systematic review and meta-analysis. Ann Surg Oncol, 2024, 31(7): 4637-4653.
19. Möbius C, Max D, Uhlmann D, et al. Five-year follow-up of a prospective non-randomised study comparing duodenum-preserving pancreatic head resection with classic Whipple procedure in the treatment of chronic pancreatitis. Langenbecks Arch Surg, 2007, 392(3): 359-364.
20. Zheng Z, Xiang G, Tan C, et al. Pancreaticoduodenectomy versus duodenum-preserving pancreatic head resection for the treatment of chronic pancreatitis. Pancreas, 2012, 41(1): 147-152.
21. Aimoto T, Uchida E, Matsushita A, et al. Long-term outcomes after Frey’s procedure for chronic pancreatitis with an inflammatory mass of the pancreatic head, with special reference to locoregional complications. J Nippon Med Sch, 2013, 80(2): 148-154.
22. Sun YH, Ding N, Cheng K, et al. Comparative analysis of duodenum-preserving pancreatic head resection and pancreaticoduodenectomy. Chin Med J (Engl), 2020, 133(17): 2112-2113.
23. Diener MK, Hüttner FJ, Kieser M, et al. Partial pancreatoduodenectomy versus duodenum-preserving pancreatic head resection in chronic pancreatitis: the multicentre, randomised, controlled, double-blind ChroPac trial. Lancet, 2017, 390(10099): 1027-1037.
24. Yin T, Wen J, Zhen T, et al. Long-term quality of life between duodenum-preserving pancreatic head resection and pancreatoduodenectomy: a systematic review and meta-analysis. Int J Surg, 2024, 110(2): 1139-1148.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Intracapsular approach used in laparoscopic duodenum-preserving total pancreatic head resection: Tongji Hospital experience

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