Benign villous adenomas of the ampulla of Vater: report of two cases.

Benign tumors of the ampulla of Vater are uncommon. We report on two patients with epigastralgia, jaundice and pancreatitis caused by villous adenoma of the ampulla of Vater, combined with biliary tract stones, who were treated at National Taiwan University Hospital. Definite diagnoses were made by endoscopic retrograde cholangiopancreatography and biopsy. Their medical unsuitability for radical pancreaticoduodenectomy led us to revive the procedure of wide local excision of these tumors with reimplantation of the pancreatic duct and double sphincteroplasty. Operative time and blood loss were substantially less, and postoperative recovery was relatively uncomplicated. Hepatic resection for intrahepatic stones was performed later in the first case. Postoperative follow-up at 2.5 years showed no tumor recurrence. We suggest that local resection of benign ampullary tumors with double sphincteroplasty is the procedure of choice in high-risk patients.