Technique of pancreaticoduodenectomy in children

Resume. Malignant pancreatic neoplasms in children and adolescents are rare. Surgery is the primary treatment for pancreatic malignant neoplasms to have disease-free survival. And the best surgical way to achieve tumor free margin for the pancreatic head tumor is Whipple procedure or pancreaticoduodenectomy (PD). PD in children is generally avoided because of absent surgical experience and high complication rate in adult population. This is a report concerning a two children 5 year girl, 1 year and 10 month boy with a solid pseudopapillary tumor and malignant teratoma respectively, which localized in the pancreatic head. In both cases primary tumors were completely resected by PD with duct-to-mucosa pancreatojejunostomy and authors method of totally isolated Roux-en-Y pancreaticobiliary tract reconstruction. There was no postoperative mortality and morbidity. The entire number of noted PD cases in very young children are extremely low, that is why the best approaches in surgical technique, anestesiology, radiological imaging and pathological assessment remain unclear. Accordingly the absence of the strong data about later physiological outcomes after PD in children we propose our method of isolated Roux-en-Y reconstruction as physiologically appropriable. PD in very young age should perform only in high experienced institutions.