Ampullectomy

Ampullectomy is indicated in the following conditions:

• Non-cancerous tumours (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 tumour size is less than or equal to 1 cm and is well-differentiated.

Ampullectomy should be avoided in the following conditions:

• Malignant periampullary cancer (cancer originating near/ around the ampulla)
• Pancreatic lesion
• Non-cancerous tumours of the ampulla that measures more than two centimetres.
• Tumour of the common bile duct that is larger than 1.5 cm
• Large noncancerous tumours located 2 cm away from the ampulla

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

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

Stages of the surgery include:

1. 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.
2. 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 tumour.
   Next, the ampulla and the lesion are identified and examined from outside the duodenum.
3. 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.
4. 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.

Ampullectomy could be safely proposed in selected familial adenomatous polyposis patients.
Our low morbidity and the absence of recurrence after almost five years of follow-up suggests that such conservative treatment could be proposed.