Procedures and operations on the duodenum are required on the one hand for patients with ulcers or polyps; however, also for those with malignant duodenal tumours or pancreatic tumours. When the duodenum is removed, the pancreas is retained where possible.
Ulcers and smaller, benign tumours (polyps) are normally dealt with during a duodenoscopy; see the chapter entitled Gastroscopy. The surgery for pancreatic cancer is explained in the chapter entitled Pancreatic surgery.
The following explanations relate to the removal of the duodenum (duodenectomy) while preserving the pancreas. This procedure is carried out most often on extensive, benign duodenal tumours or on malignant tumours which are restricted to the duodenum.
What preparations are carried out before the procedure?
Different examinations such as an ultrasound, computer tomography or duodenoscopy are performed before the procedure. All the usual pre-operative assessments, such as a blood test, blood pressure measurement and an ECG, are also required beforehand.
All blood-thinning medication must be discontinued before the procedure takes place. Duodenal surgery is performed under general anaesthetic. Patients should therefore have an empty stomach for the procedure.
How is the operation performed?
Duodenal surgery in which the pancreas is retained is known as pancreas-preserving duodenectomy. The procedure is usually carried out as an open operation by opening the abdominal wall (laparotomy). After this is done, the duodenum is severed and removed. The remaining ends are then reconnected. A new opening is created for the pancreatic duct in the small intestine (jejeunum), which contains digestive enzymes and leads into the small intestine, and also for the bile duct, which transports bile fluid.
Pancreatic duodenectomy is a comprehensive and complex operation which is carried out in specialist centres.
What is the success rate of this procedure?
This procedure usually remedies the disease if the tumour is benign. If it is malignant, the prognosis depends on the type of tumour and the stage of the cancer.
What are the possible complications and risks of this procedure?
Duodenal surgery may occasionally cause post-operative haemorrhaging, nerve damage and infections. The newly created intestinal connection or the transplanted pancreatic duct opening can sometimes not function properly.
What happens after the operation?
The patient is monitored in the recovery room until they wake up. The drainage tubes are usually removed in one or two days. Patients who undergo this operation must usually stay in hospital for 3 to 5 days. They should avoid major physical exertion for 6 to 8 weeks after the operation.
The healing process is monitored with regular follow-up examinations.