Surgical method choice and coincidence rate of pathological diagnoses in transduodenal ampullectomy: A retrospective case series study and review of the literature

Figure 4 Surgical procedure. A: Kocher incision, dissociation of the lateral peritoneum of the duodenal descending portion, exposure of the duodenal descending portion, and search for the position of the duodenal papilla; lesions were accurately detected; B: Anterior wall of the duodenum; lengthwise incision at the duodenal descending section showing the periampullary lesions; C: Exposure and lifting of the duodenal papilla using a transfixion suture; D: Maintaining an appropriate distance around the base of the periampullary tumor, we cut open the duodenal mucosa and the mucosal muscularis; E: The common bile duct and the main pancreatic duct end were anastomosed with the duodenal wall using interrupted sutures; F: The bile duct and the pancreatic duct passed through the biliary probes after replantation; G: Complete resection of the periampullary tumor; H: The supporting tube was inserted into the main pancreatic duct and fixed; I: The duodenal intestinal wall was closed with single-layer longitudinal suturing using absorbable sutures.