Wide ampullectomy for patients with villous adenoma of duodenal papilla and follow-up results of pancreaticobiliary tract.

Of 14 patients with ampullary tumor (11: carcinoma, 3: adenoma) treated during the last 8 years, two of 3 patients with adenoma underwent wide ampullectomy. We report herein the surgical procedure and its outcome with a special reference to the pancreaticobiliary ductal system with a mean follow-up period of 3.8 years. The procedure consisted of wide excision of the papilla encompassing the duodenal wall, the distal segments of pancreatic and common bile ducts, and a part of the pancreatic tissue adjacent to the duodenum. The distal ends of pancreatic and common bile ducts were sutured in a common duct manner and the openings were approximated to the excised duodenal wall. The pathological diagnosis was tubulo-villous adenoma with moderate atypia in both cases. The postoperative complications were absent except for a transient duodenal stenosis in one case. They have been free of recurrence and none developed pancreatobiliary diseases at the time of writing 49 and 44 months after ampullectomy. The duodenoscope clearly demonstrated the openings of the pancreatic and bile ducts and both ducts were not dilated on the endoscopic retrograde cholangiopancreaticogram. Wide ampullectomy is a choice of treatment for adenoma of papilla of Vater because of its non invasiveness and uneventful postoperative course.