Abstract
Aim of the Study: The duodenum preserving head resection of the pancreas (DPHRP) with Roux-en-Y pancreaticojejunostomy is a technique that is used in adult patients for the treatment of pathological focal lesions of the pancreatic head. However, this technique is safe and effective even in children. We reviewed our indications, complications and long-term outcomes of the technique. Methods: Retrospective analysis of pediatric patients who underwent DPHRP between 1994 and 2015 was performed. The collected data included diagnostic evaluation, description of the pathology in operation protocol, histology, complications and long-term follow-up results. Main
Result: There were 21 patients operated on, 14 girls and 7 boys, who on average were 11.8 years old (3 months - 18.4 years). In 17 of the patients with involvement of the pancreatic head only DPHRP and the end-to-end anastomosis of the excluded jejunum to the pancreatic body (Roux-en-Y anastomosis) were performed. In 4 of the patients the head and also part of the body of the pancreas was resected. The indication for DPHRP was a solid pseudopapillary tumor of the pancreas (SPTP) in 10 children, trauma in 8, pancreas divisum, focal congenital hyperinsulinism and pancreatic cyst in one. All the patients have been followed up 9 months to 21 years postoperatively (8.3 years on average). One patient developed a biliary fistula which closed spontaneously within two weeks after stent insertion. Two patients complained of recurrent abdominal pain one year and 7 months post-operatively respectively. Currently 21 patients had no endocrine pancreatic insufficiency, 6 need low-fat diet and 5 need pancreatic enzyme supplementation. Conclusion:
The duodenum preserving head resection with Roux-en-Y pancreaticojejunostomy is a safe and effective procedure for the treatment of large focal pathological lesions of the pancreatic head in children. Compared to duodeno- pancreatectomy, it is less invasive and mutilating and therefore more appropriate for the developing child