Head dorsal pancreatectomy: An alternative to the pancreaticoduodenectomy for not enucleable benign or low-grade malignant lesions

Background: Head dorsal pancreatectomy (HDP) is a segmental pancreatic resection, conservative variant of total dorsal pancreatectomy, applied to preserve the functional pancreatic parenchyma as an alternative to pancreaticoduodenectomy in not enucleable benign or low-grade malignant lesions. The absences of biliary and gastrointestinal resection/reconstruction are the other advantages of the technique. Methods: We reported a case of HDP performed in a female 39-year-old patient for a neuroendocrine tumour of the dorsal portion of the pancreatic head. Results: The superior mesenteric vein was dissected from the pancreatic neck. The pancreas was transected at the left margin of the superior mesenteric vein. After identification and mobilisation of gastroduodenal artery and the anterior superior pancreatico-duodenal artery, the head dorsal segment was dissected stepwise from the duodenal wall toward the common bile duct plane; the dissection of the pancreatic parenchyma was completed along the anterior surface of the common bile duct. An end-to-side duct-to-mucosa pancreaticojejunostomy was performed. The main pancreatic duct in the ventral segment on the dissection parenchymal surface was ligated. With the inclusion of this case, there are a total of 3 cases involving resection of the dorsal portion of the pancreatic head reported in the literature. Conclusion: HDP seems to be technically feasible and safe for not enucleable benign or low-grade malignant neoplasms involving the dorsal pancreatic head. However, due to the singularity of the indications and the few cases reported in the literature, further studies are needed to validate the technique. Copyright (C) 2014, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved.