Pancreas preserving distal duodenectomy: A versatile operation for a range of infra-papillary pathologies

Figure 4 Operative technique. After wide Kocherisation (A) the papilla and lesion are palpated. For benign pathology close to the papilla, the ampullary complex can be further protected by cannulation (B). The proximal jejunum is transected (C), the distal duodenum taken off its short vessels and the resection is completed (D). Reconstruction is by a retrocolic isoperistaltic side-to-side duodenojejunostomy (E).