Surgical ampullectomy with resection of the common bile duct for biliary papillomatosis
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MULTIMEDIA ARTICLE
Surgical ampullectomy with resection of the common bile duct for biliary papillomatosis Justine Khodr 1,2 & Stéphanie Truant 1,2 & Mehdi El Amrani 1,2 Received: 29 June 2020 / Accepted: 27 October 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Background Intraductal papillary neoplasm of the bile duct (IPNB) or biliary papillomatosis is a precursor lesion of papillary cholangiocarcinoma.1 IPNB is recognized as a biliary counterpart of IPMN (pancreatic intraductal papillary mucinous neoplasm). IPNB is a rare disease involving entire (diffuse type) or one part (localized type) of biliary tree. Patients without distant metastasis are considered for surgical resection. For patients with distal bile duct papillomatosis, pancreaticoduodenectomy (PD) is recommended for patients with invasive distal bile duct IPNB. PD is a high complex procedure associated with the deterioration of endocrine and exocrine functions leading to a significant impact on quality of life.2 Some authors have reported a new surgical approach leading to a complete resection of the common bile duct without pancreatectomy.3 Methods We report the case of a 71-year-old female presented to our department with jaundice. At endoscopic ultrasound with cholangioscopy and CT scan, 2-cm distal bile duct mass tumor with villous component was seen. All needle biopsies were benign, and no distant disease was found. According to the risk of degeneration of this tumor, a surgical resection was decided. Results Intraoperative frozen section assessed the benignity of peripancreatic lymph nodes. We performed surgical ampullectomy with resection of the common bile duct. The intrapancreatic common bile duct was completely mobilized between the ampullectomy area and the upper edge of the pancreas. Frozen sections on distal and proximal margins of common bile duct were performed to discard malignancy. Finally, reconstruction consisted on the main pancreatic duct reimplantation to the duodenum and choledochoduodenostomy. The histological analysis confirmed the diagnosis of biliary papillomatosis with low-grade dysplasia. Conclusion This procedure allows complete resection of benign tumors with endobiliary extension and preserve intestinal continuity and pancreatic parenchyma. Keywords Common bile duct . Resection . Ampullectomy . Papillomatosis
The different steps are detailed in the video and Figs. 1, 2, 3, and 4.
Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s11605-02004851-9. * Mehdi El Amrani [email protected] 1
Department of Digestive Surgery and Transplantation, Lille University Hospital, Rue Michel Polonovski, 59037 Lille, France
2
University of Lille, Lille, France
J Gastrointest Surg
Fig. 4 Specimen of intrapancreatic bile duct resection
Fig. 1 Surgical ampullectomy completed by the cut of main pancreatic and common biliary ducts
Compliance with ethical standards Conflict of interest The authors declare that they have no conflict of inte
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