This is an operation to remove the ampulla of Vater. This is a structure located in the duodenum, and marks the point at which the bile duct as well as the pancreatic duct empties into the small intestine (see diagram). Bile and pancreatic juice will flow into the duodenum through the ampulla.
The ampulla has a small risk of developing a tumour. In the past, tumours of the ampulla will automatically need a Whipple operation. Recent research has found that for early stages of such tumours, a lesser operation is enough, and this operation is the transduodenal ampullectomy. There is even a form of ampullectomy where the doctor uses the endoscope to remove the ampulla. This is reserved for a very selected group of patients where the tumour is really small and before it has developed into frank cancer.
This operation is performed under general anaesthesia. In addition, the anaesthetist may place an epidural catheter for epidural analgesia. This provides excellent pain relief following the surgical operation.
General information about the transduodenal ampullectomy
Your surgeon will assess your general health status. Blood tests, chest X-ray and electro-cardiogram (ECG) may be done if needed. The purpose of these tests is to ensure that you are healthy and fit enough to proceed with the operation under general anaesthesia.
You may be admitted one day before the operation. However, for selected patients, based on their general conditions, they need just come to the hospital on the day of their operation.
Just remember that you cannot eat or drink anything for 6 hours before the operation.
Your anaesthetist will put you to sleep first before we start. You will have a catheter placed into your bladder to drain the urine. A tube will also be placed through one of your nostril into the stomach to empty the stomach.
The operation is broadly divided into 2 phases:
Phase 1 – phase of resection.
The surgeon will first remove the ampulla.
Phase 2 – phase of reconstruction.
During this phase, the surgeon will re-establish the digestive tract by suturing the bile duct and the pancreatic duct back to the small intestine (duodenum). Because the ducts are very small structures, this part of the operation is usually performed under magnification.
Depending on the condition, the entire operation may last from 3 hours to 5 hours.
The patient will be nursed in the General Ward. Occasionally, some patients may be observed in the High Dependency Ward for the first day.
The patient will have a nasogastric tube and a urine catheter. In addition, there will be one to two surgical tubes placed into the abdomen to remove any residual fluid or blood. The patient will not be allowed to eat for a couple of days. Intravenous fluid will be given to the patient for hydration as well as nutrition.
You are encouraged to be as active as possible. Whilst in bed, you may turn any way that is comfortable. Do frequent calf and leg exercises by pointing your toes back towards your knee and then pointing them towards the foot of the bed. Repeat this 10 times every hour if possible. This exercise prevents deep vein thrombosis. You will need to cough and do deep breathing exercises. This will reduce your risk of getting a chest infection.
The average length of stay following a transduodenal ampullectomy is 7 to 10 days. However the length of stay may vary in individuals. If there are any complications, the length of stay will be prolonged.
Some of the risks associated with the transduodenal ampullectomy can be read here.
An appointment date will be given to you to return for a follow up consultation, usually in about a week.
Please contact your Nexus Surgical surgeon at our 24-hr hotline (+65 6333 5550) if you experience the following:
- Fever more than 38oC
- Severe pain and redness at the wound site
- Discharge from the incisions such as pus and excessive bleeding
- Jaundice (yellowing of skin)
- Severe abdominal pain and bloating