Background : Our patient underwent an open trans-duodenal ampullectomy for a low grade ampullary dysplastic lesion. Unfortunately post operative histopathology showed a focus of adenocarcinoma. MDT made a decision to offer pancreatico-duodenectomy. The patient underwent a laparoscopic pancreatico-duodenectomy 1 month after the first open surgery. It was technically difficult procedure. We present a video presentation of the operation with emphasis on technical steps performed

Methods : A video presentation of a laparoscopic pancreatico-duodenectomy after an open trans-duodenal ampullectomy

Results : Operative time was 8 hours, operative blood loss was 280mls. There was no post operative complications. Length of stay was 5 days. Patient was re-admitted for gastroparesis after 1 week for gastroparesis that settled with conservative measures. Post-operative histopathology showed adenocarcinoma with R0 margins.

Conclusions : Laparoscopic Pancreatico-duodenectomy is feasible as a redo-surgery inspite of having an open trans-duodenal ampullectomy.