Ampullectomies pour lésions a priori bénignes: Indications et résultats

Abstract

Background. - Surgical resection remains today the standard treatment of ampullary and papilla tumours. Whether pancreaticoduodenectomy (PD) or ampullectomy is indicated for presumed benign lesions remains debated. The feared potential post-operative morbidity of ampullectomies is balanced by the functional sequelae of PD. Aim of the study. - This work reports our experience of ampullectomies for presumed benign lesion of the ampulla and papilla and analyses the indications and results of ampullectomies, considering both our series and published series of the literature. Methods. - Since 1997, eight ampullectomies with frozen section have been performed for presumed benign lesions, taking account of morphologic criteria and pre-operative endoscopic biopsies. Results. - Post-operative mortality was nil. Post-operative morbidity included one bilio-enteric fistula and four acute pancreatitis, all treated conservatively. Final pathological examination showed one benign and one malignant ampullomas, one benign fibrous stenosis of the papilla, one duodenal duplication and one choledococele, two adenomas and one adenomyomatosis of the papilla in patients with familial adenomatous polyposis (FAP). During follow-up, one de novo duodenal adenoma in FAP and one benign stenosis of the papilla were observed and treated endoscopically. All other patients remain asymptomatic. Conclusion. - Ampullectomy with accurate intra-operative frozen section appears adequate for presumed benign lesion of the papilla and ampulla. © 2003 Elsevier SAS. © 2003 Elsevier SAS. Tous droits réservés.