Abstract

Periampullary tumours consist of adenocarcinoma of the head, neck and uncinate process of the pancreas, ampulla, distal common bile duct and ampullary duodenum.⁽¹⁾   Pancreaticoduodenectomy since its initial description in 1935 by Whipple et al and with its various modifications henceforth, is the standard surgical treatment for the malignancies described above. In 2006,Pessaux et al described the “SMA first approach” of pancreaticoduodenectomy which includes the dissection of the origin of the superior mesenteric artery first, thus saving the surgeons from reaching a point of no return in cases of involvement of superior mesenteric artery in classical pancreaticoduodenectomy.⁽²⁾ Subtotal stomach preserving pancreaticoduodenectomy was described in the 1990s in Japan. It involves division of the stomach 3-4 cm proximal to the pylorus, thus retaining much of the body of the stomach. We report the case of a 35 year old lady who presented to the emergency with obstructive jaundice. On evaluation CEMR with MRCP showed narrowing in the terminal CBD with wall thickening and upstream biliary dilatation without a definite conclusion. The total bilirubin level remained static for almost 3 weeks. The Endoscopy report was inconclusive. We decided to proceed with Whipple’s pancreaticoduodenectomy by the “SMA first approach” and Subtotal stomach preserving Pancreaticoduodenectomy. The patient recovered well without any major complication and was discharged on the 14^th post operative day.