The core techniques and key points of laparoscopic duodenum-preserving total pancreatic head resection_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Pengrui ,  WANG Lei

Department of Pancreatic Surgery, Qilu Hospital of Shandong University, Ji’nan 250012, P. R. China;

Corresponding author：

WANG Lei, Email: qlwanglei1102@163.com

Keywords：

laparoscopic duodenum-preserving total pancreatic head resection; core technique; fluorescence imaging; common bile duct

DOI：

10.7507/1007-9424.202502036

Video：

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In order to protect the integrity and function of the digestive system, duodenum-preserving total pancreatic head resection is becoming the surgical method which was chosen by more and more doctors for benign lesions or low-grade malignant tumors of the pancreatic head. With the development of minimally invasive concepts and techniques, laparoscopic technology has brought unique advantages to this surgery. In this paper, a series of problems such as the development process and indications of laparoscopic duodenum-preserving total pancreatic head resection were discussed, and the core techniques of surgery and how to reduce the occurrence of complications were emphasized. The aim is to improve the therapeutic effect and quality of life of patients through reasonable surgical methods and treatment strategies.

Citation： WANG Pengrui, WANG Lei. The core techniques and key points of laparoscopic duodenum-preserving total pancreatic head resection. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(2): 148-151. doi: 10.7507/1007-9424.202502036 Copy

1.	Beger HG, Krautzberger W, Bittner R, et al. Duodenum-preserving resection of the head of the pancreas in patients with severe chronic pancreatitis. Surgery, 1985, 97(4): 467-473.
2.	Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis. Pancreas, 1987, 2(6): 701-707.
3.	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.
4.	Imaizumi T, Hanyu F, Suzuki M. A new procedure for duodenum-preserving total resection of the head of the pancreas with pancreaticocholedochoduodenostomy. Springer Berlin Heidelberg, 1993: 464-470.
5.	Takada T, Yasuda H, Amano H, et al. A duodenum-preserving and bile duct-preserving total pancreatic head resection with associated pancreatic duct-to-duct anastomosis. J Gastrointest Surg, 2004, 8(2): 220-224.
6.	郭诗翔, 王槐志. 保留十二指肠、胆总管、Oddi’ 氏括约肌的胰头整块全切除术. 中华普外科手术学杂志 (电子版), 2021, 15(4): 374.
7.	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.
8.	Kumar KH, Garg S, Yadav TD, et al. Anatomy of peripancreatic arteries and pancreaticoduodenal arterial arcades in the human pancreas: a cadaveric study. Surg Radiol Anat, 2021, 43(3): 367-375.
9.	杨永君, 向吉锋, 王槐志. 保留十二指肠、胆总管、Oddi’s括约肌的胰头整块全切除术 (王氏手术) 的手术要点及应用. 中国普外基础与临床杂志, 2025, 32(2): 143-147.
10.	Yu J, Lin Z, Chen Z, et al. Laparoscopic duodenum-preserving pancreatic head resection via inferior infracolic approach: a surgical approach for benign lesions. J Vis Exp, 2024, (204): e66251. doi: 10.3791/66251.
11.	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.
12.	Chen X, Chen W, Zhang Y, et al. Short-term outcomes of laparoscopic duodenum-preserving total pancreatic head resection compared with laparoscopic pancreaticoduodenectomy for the management of pancreatic-head benign or low-grade malignant lesions. Med Sci Monit, 2020, 26: e927248. doi: 10.12659/MSM.927248.
13.	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.
14.	Osayi SN, Wendling MR, Drosdeck JM, et al. Near-infrared fluorescent cholangiography facilitates identification of biliary anatomy during laparoscopic cholecystectomy. Surg Endosc, 2015, 29(2): 368-375.
15.	Gao Y, Li M, Song ZF, et al. Mechanism of dynamic near-infrared fluorescence cholangiography of extrahepatic bile ducts and applications in detecting bile duct injuries using indocyanine green in animal models. J Huazhong Univ Sci Technolog Med Sci, 2017, 37(1): 44-50.
16.	Keck T, Wellner UF, Bahra M, et al. Pancreatogastrostomy versus pancreatojejunostomy for RECOnstruction after PANCreatoduodenectomy (RECOPANC, DRKS 00000767): perioperative and long-term results of a multicenter randomized controlled trial. Ann Surg, 2016, 263(3): 440-449.
17.	Hong D, Xin Y, Cai X, et al. Application of binding pancreatogastrostomy in laparoscopic central pancreatectomy. World J Surg Oncol, 2012, 10: 223. doi: 10.1186/1477-7819-10-223.
18.	Choe YM, Lee KY, Oh CA, et al. Risk factors affecting pancreatic fistulas after pancreaticoduodenectomy. World J Gastroenterol, 2008, 14(45): 6970-6974.
19.	Grobmyer SR, Kooby D, Blumgart LH, et al. Novel pancreaticojejunostomy with a low rate of anastomotic failure-related complications. J Am Coll Surg, 2010, 210(1): 54-59.
20.	Hirono S, Kawai M, Okada KI, et al. Modified blumgart mattress suture versus conventional interrupted suture in pancreaticojejunostomy during pancreaticoduodenectomy: randomized controlled trial. Ann Surg, 2019, 269(2): 243-251.
21.	徐建威, 李峰, 叶乃宽, 等. 腹腔镜胰管对黏膜胰肠吻合在胰腺中段切除术中的应用. 腹腔镜外科杂志, 2019, 24(9): 684-687.
22.	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.
23.	Qin H, Yang S, Yang W, et al. Duodenum-preserving pancreas head resection in the treatment of pediatric benign and low-grade malignant pancreatic tumors. HPB (Oxford), 2020, 22(2): 306-311.
24.	Horiguchi A, Miyakawa S, Ishihara S, et al. Surgical design and outcome of duodenum-preserving pancreatic head resection for benign or low-grade malignant tumors. J Hepatobiliary Pancreat Sci, 2010, 17(6): 792-797.
25.	Beger HG, Mayer B, Vasilescu C, et al. Long-term metabolic morbidity and steatohepatosis following standard pancreatic resections and parenchyma-sparing, local extirpations for benign tumor: a systematic review and meta-analysis. Ann Surg, 2022, 275(1): 54-66.
26.	Kato H, Isaji S, Azumi Y, et al. Development of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) after pancreaticoduodenectomy: proposal of a postoperative NAFLD scoring system. J Hepatobiliary Pancreat Sci, 2010, 17(3): 296-304.

1. Beger HG, Krautzberger W, Bittner R, et al. Duodenum-preserving resection of the head of the pancreas in patients with severe chronic pancreatitis. Surgery, 1985, 97(4): 467-473.
2. Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis. Pancreas, 1987, 2(6): 701-707.
3. 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.
4. Imaizumi T, Hanyu F, Suzuki M. A new procedure for duodenum-preserving total resection of the head of the pancreas with pancreaticocholedochoduodenostomy. Springer Berlin Heidelberg, 1993: 464-470.
5. Takada T, Yasuda H, Amano H, et al. A duodenum-preserving and bile duct-preserving total pancreatic head resection with associated pancreatic duct-to-duct anastomosis. J Gastrointest Surg, 2004, 8(2): 220-224.
6. 郭诗翔, 王槐志. 保留十二指肠、胆总管、Oddi’ 氏括约肌的胰头整块全切除术. 中华普外科手术学杂志 (电子版), 2021, 15(4): 374.
7. 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.
8. Kumar KH, Garg S, Yadav TD, et al. Anatomy of peripancreatic arteries and pancreaticoduodenal arterial arcades in the human pancreas: a cadaveric study. Surg Radiol Anat, 2021, 43(3): 367-375.
9. 杨永君, 向吉锋, 王槐志. 保留十二指肠、胆总管、Oddi’s括约肌的胰头整块全切除术 (王氏手术) 的手术要点及应用. 中国普外基础与临床杂志, 2025, 32(2): 143-147.
10. Yu J, Lin Z, Chen Z, et al. Laparoscopic duodenum-preserving pancreatic head resection via inferior infracolic approach: a surgical approach for benign lesions. J Vis Exp, 2024, (204): e66251. doi: 10.3791/66251.
11. 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.
12. Chen X, Chen W, Zhang Y, et al. Short-term outcomes of laparoscopic duodenum-preserving total pancreatic head resection compared with laparoscopic pancreaticoduodenectomy for the management of pancreatic-head benign or low-grade malignant lesions. Med Sci Monit, 2020, 26: e927248. doi: 10.12659/MSM.927248.
13. 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.
14. Osayi SN, Wendling MR, Drosdeck JM, et al. Near-infrared fluorescent cholangiography facilitates identification of biliary anatomy during laparoscopic cholecystectomy. Surg Endosc, 2015, 29(2): 368-375.
15. Gao Y, Li M, Song ZF, et al. Mechanism of dynamic near-infrared fluorescence cholangiography of extrahepatic bile ducts and applications in detecting bile duct injuries using indocyanine green in animal models. J Huazhong Univ Sci Technolog Med Sci, 2017, 37(1): 44-50.
16. Keck T, Wellner UF, Bahra M, et al. Pancreatogastrostomy versus pancreatojejunostomy for RECOnstruction after PANCreatoduodenectomy (RECOPANC, DRKS 00000767): perioperative and long-term results of a multicenter randomized controlled trial. Ann Surg, 2016, 263(3): 440-449.
17. Hong D, Xin Y, Cai X, et al. Application of binding pancreatogastrostomy in laparoscopic central pancreatectomy. World J Surg Oncol, 2012, 10: 223. doi: 10.1186/1477-7819-10-223.
18. Choe YM, Lee KY, Oh CA, et al. Risk factors affecting pancreatic fistulas after pancreaticoduodenectomy. World J Gastroenterol, 2008, 14(45): 6970-6974.
19. Grobmyer SR, Kooby D, Blumgart LH, et al. Novel pancreaticojejunostomy with a low rate of anastomotic failure-related complications. J Am Coll Surg, 2010, 210(1): 54-59.
20. Hirono S, Kawai M, Okada KI, et al. Modified blumgart mattress suture versus conventional interrupted suture in pancreaticojejunostomy during pancreaticoduodenectomy: randomized controlled trial. Ann Surg, 2019, 269(2): 243-251.
21. 徐建威, 李峰, 叶乃宽, 等. 腹腔镜胰管对黏膜胰肠吻合在胰腺中段切除术中的应用. 腹腔镜外科杂志, 2019, 24(9): 684-687.
22. 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.
23. Qin H, Yang S, Yang W, et al. Duodenum-preserving pancreas head resection in the treatment of pediatric benign and low-grade malignant pancreatic tumors. HPB (Oxford), 2020, 22(2): 306-311.
24. Horiguchi A, Miyakawa S, Ishihara S, et al. Surgical design and outcome of duodenum-preserving pancreatic head resection for benign or low-grade malignant tumors. J Hepatobiliary Pancreat Sci, 2010, 17(6): 792-797.
25. Beger HG, Mayer B, Vasilescu C, et al. Long-term metabolic morbidity and steatohepatosis following standard pancreatic resections and parenchyma-sparing, local extirpations for benign tumor: a systematic review and meta-analysis. Ann Surg, 2022, 275(1): 54-66.
26. Kato H, Isaji S, Azumi Y, et al. Development of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) after pancreaticoduodenectomy: proposal of a postoperative NAFLD scoring system. J Hepatobiliary Pancreat Sci, 2010, 17(3): 296-304.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The core techniques and key points of laparoscopic duodenum-preserving total pancreatic head resection

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