What is an ampullectomy?

Procedure
Ampullectomy can be performed as open surgery and laparoscopic surgery.

An ampullectomy is the surgical removal of the entire ampulla of Vater. The ampulla of Vater or ampulla is the small projection into the duodenum through which bile and pancreatic secretions flow to mix with food for digestion.

Ampullectomy can be performed as:

  • Open surgery
  • Laparoscopic surgery (key-hole surgery)

When is ampullectomy indicated?

Ampullectomy is indicated in the following conditions:

  • Noncancerous tumors (benign) of the ampulla smaller than 2 cm and located within 2 cm of the ampulla.
  • Early stages of cancer of ampulla (ampullary cancer), where the tumor size is less than or equal to 1 cm and is well-differentiated.

When should ampullectomy be avoided?

Ampullectomy should be avoided in the following conditions:

  • Malignant periampullary cancer (cancer originating near/ around the ampulla)
  • Pancreatic lesion
  • Noncancerous tumors of the ampulla that measures more than two centimeters
  • Tumor of the common bile duct that is larger than 1.5 cm
  • Large noncancerous tumors located 2 cm away from the ampulla

How to prepare for an ampullectomy surgery

Before undergoing ampullectomy, the patient must be aware of the risks and benefits of the surgery. The patient should be aware of the following information before undergoing ampullectomy:

  • Ampullectomy is major surgery, and the patient must be able to tolerate the risk of general anesthesia.
  • The patient must undergo certain laboratory tests, imaging tests and physical examinations before the surgery.
  • The surgeon will explain the complications of the surgery.
  • During the surgery, if a new cancerous tumor is detected, further surgeries may be indicated.
  • The patient must list medical and medication history to the physician
  • The doctor assesses the patient’s overall health to check if they arefit to undergo the surgery.

How is ampullectomy surgery performed?

Before the surgery, the surgeon will administer general anesthesia. The patient lies flat on the table. 

Stages of the surgery include:

  • Laparotomy and evaluation
    • Once the patient becomes unconscious, the surgeon makes an incision in the middle of the abdomen. 
    • Once the incision is made, the physician explores the abdominal cavity and the liver
  • Exposure of duodenum and ampulla
    • After the exploration, the duodenum and pancreatic head are moved away (mobilized) from their attachment. 
    • The pancreatic head is examined for any tumor. 
    • Next, the ampulla and the lesion are identified and examined from outside the duodenum. 
  • Resection
    • The surgeon carefully identifies the pancreatic and bile ducts.
    • Superficial cancerous cells on the ampulla are surgically removed (excised) with the help of needle-tip electrocautery. 
    • Both the pancreatic and bile ducts are marked with stitches before completing the excision.
  • Reconstruction
    • To prepare for reconstruction, the surgeon creates a common opening for the pancreatic and bile ducts by a single stitch. 
    • Subsequently, ducts are reinstated, and the duodenal wall is closed with stitches to complete closure.
    • Drains are placed before closing the abdomen.

What are the risks and complications of ampullectomy surgery?

After the surgery, drains are taken out once oral intake has been restored, without complications. In the case of infections, antibiotics will be prescribed. 

Complications of ampullectomy include:

  • Pancreatitis (inflammation of the pancreas)
  • Infection
  • Death during operation
  • Narrowing of the duodenum, pancreas or bile
  • Hemorrhage inside duodenum
  • Leakage from the duodenum, bile or pancreas

QUESTION

Pancreatitis is inflammation of an organ in the abdomen called the pancreas. See Answer

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Medically Reviewed on 7/8/2020
References
Medscape Medical Reference

UpToDate.com
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