Pancreaticoduodenectomy

Pancreaticoduodenectomy
Intervention
The pancreas, stomach, and bowel are joined back together after a pancreaticoduodenectomy
ICD-9-CM	52.7
MeSH	D016577
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A pancreaticoduodenectomy, pancreatoduodenectomy,Whipple procedure, or Kausch-Whipple procedure, is a major surgical operation involving the removal of the head of the pancreas, the duodenum, the proximal jejunum, gallbladder, and part of the stomach. This operation is most often performed to remove cancerous or pre-cancerous tumours of the head of the pancreas or one of the related structures (Ampulla of Vater, duodenum or bile duct). Less commonly, it may be used for the management of pancreatic or duodenal trauma, or chronic pancreatitis.

The most common technique of a pancreaticoduodenectomy consists of the en bloc removal of the distal segment (antrum) of the stomach, the first and second portions of the duodenum, the head of the pancreas, the common bile duct, and the gallbladder.

The basic concept behind the pancreaticoduodenectomy is that the head of the pancreas and the duodenum share the same arterial blood supply (the gastroduodenal artery). These arteries run through the head of the pancreas, so that both organs must be removed if the single blood supply is severed. If only the head of the pancreas were removed it would compromise blood flow to the duodenum, resulting in tissue necrosis.

The Whipple procedure today is very similar to Whipple's original procedure. It consists of removal of the distal half of the stomach (antrectomy), the gall bladder and its cystic duct (cholecystectomy), the common bile duct (choledochectomy), the head of the pancreas, duodenum, proximal jejunum, and regional lymph nodes. Reconstruction consists of attaching the pancreas to the jejunum (pancreaticojejunostomy), attaching the hepatic duct to the jejunum (hepaticojejunostomy) to allow digestive juices and bile respectively to flow into the gastrointestinal tract, and attaching the stomach to the jejunum (gastrojejunostomy) to allow food to pass through. Whipple originally used the sequence: bile duct, pancreas and stomach, whereas presently the popular method of reconstruction is pancreas, bile duct and stomach, also known as Child's operation.