Name of the Procedure:

Excision of Ampulla of Vater
Common name(s): Ampullectomy
Technical terms: Resection of the ampulla of Vater

Summary

The excision of the ampulla of Vater is a surgical procedure where the ampulla—a small projection located where the bile duct and pancreatic duct meet and enter the small intestine—is removed. This procedure is typically performed to address obstructions, tumors, or other pathological changes in this region.

Purpose

The excision of the ampulla of Vater is performed to treat conditions such as benign or malignant tumors, obstructions, or inflammation in the ampulla. The goals of the procedure include removing diseased tissue, alleviating symptoms such as jaundice or pancreatitis, and preventing further complications.

Indications

• Symptoms such as jaundice, abdominal pain, or pancreatitis
• Suspicion or diagnosis of ampullary cancer
• Benign tumors or growths causing obstruction
• Chronic pancreatitis or bile duct problems localized at the ampulla

Preparation

• Patients are typically required to fast for at least 8 hours before the procedure.
• Pre-procedure imaging tests like an MRI, CT scan, or endoscopic retrograde cholangiopancreatography (ERCP) may be required.
• Medication adjustments, particularly blood thinners, may be necessary.
• A thorough medical examination and history review will be conducted.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the abdomen to access the duodenum.
3. Identifying the ampulla of Vater, carefully resect it using specialized surgical instruments.
4. The bile and pancreatic ducts are reconnected to allow normal digestive function.
5. The incision is sutured closed and dressings are applied.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity and extent of the surgery required.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Surgeon
• Surgical assistants
• Anesthesiologist
• Operating room nurses

Risks and Complications

• Common: Infection, bleeding, pain at the incision site.
• Rare: Injury to surrounding organs (pancreas, bile ducts), leakage of bile or pancreatic fluids, delayed gastric emptying, pancreatitis, and need for additional surgeries.
• Complications are managed through medications, additional procedures, and close post-operative monitoring.

Benefits

• Relief from symptoms such as jaundice, abdominal pain, and digestive issues.
• Removal of malignant or precancerous growths, reducing cancer risk.
• Improved quality of life and functionality of digestive organs.

Recovery

• Patients may need to stay in the hospital for 5-7 days post-surgery.
• Initial recovery involves pain management, gradual reintroduction to eating, and monitoring organ functions.
• Full recovery may take several weeks; patients are advised to avoid strenuous activities during this period.
• Follow-up appointments are crucial for assessing recovery and addressing any complications.

Alternatives

• Endoscopic Ampullectomy: Less invasive but may not be suitable for all cases.
• Stent placement: Temporary relief for obstructions.
• Observation and Symptom Management: In cases where surgical risks outweigh benefits.
• Pros and Cons: Less invasive procedures like endoscopic ampullectomy have quicker recovery times but may not fully address severe conditions.

Patient Experience

• During the procedure, the patient will be under general anesthesia and will not feel pain.
• Post-surgery, patients might experience discomfort or pain controlled by medications.
• Fatigue, temporary dietary restrictions, and limited physical activity are expected during recovery.
• Close medical supervision ensures proper healing and addresses any immediate post-operative concerns.