Ampullectomy

The ampulla of Vater is an anatomical structure located in the second portion of the duodenum where the bile duct and the pancreatic duct converge. The local resection approach is an alternative treatment for ampullary lesions, but its utility is limited to a narrow range of indications. Adenocarcinoma represents 90% of ampullary tumors, but generally requires more extensive surgery. The most typical indication is a benign lesion, where adenomas are the most frequent. Preoperative evaluation is essential for determining presence of invasion into neighboring structures. The classic approach is surgical ampullectomy (SA), but minimally invasive techniques and endoscopic ampullectomy (EP) for early-stage tumors have also been developed. We have schematically summarized the surgery in the following steps: (1) position of the patient and exposition of the second portion of the duodenum, (2) exposition and approach of the ampulla of Vater, (3) resection of the lesion, (4) reimplantation of the bile duct and pancreatic duct and (5) closure of the duodenum.