The technique of papilloduodenectomy.

Papilloduodenectomy consists of precise and wide resection of the papilla of Vater, performed by stepwise incision of the posterior duodenal wall around the papilla, with sequential hemostasis followed by suture placement between the duodenal wall and bile duct. The end results after completion of the resection assures fixation of the biliary and pancreatic duct to the posterior wall of the duodenum, which minimizes the risk of biliary or pancreatic leakage. Results of local excision of the papilla of Vater for periampullary tumors appear satisfactory and this procedure may be particularly indicated for older or higher risk patients. Pancreaticoduodenectomy should probably remain the procedure of choice for reasonably fit patients with established malignant disease.