Whipples Procedure

Pancreaticoduodenectomy (Whipple Procedure)

Objective

In case of:

•   To remove the head of the pancreas

•   The entire duodenum

•   The very proximal portion of the jejunum

•   The distal third of the stomach

•   The distal half of the common bile duct

•   Re-establishment of continuity of the biliary, pancreatic and gastrointestinal tracts.

Position

Supine.

Anesthesia

General.

Procedure

   1.  A transverse, midline, or paramedian incision.

   2.  Operability is assessed.

   3.  Kocherise duodenum.

   4.  Mobilize common bile duct-carry out a cholecystectomy.

   5.  Divide the bile duct at the level of the common hepatic duct level.

   6.  Divide right gastric and gastroduodenal artery to reach the portal vein.

   7.  The superior mesenteric vein is identified at the inferior border of the pancreas.

   8.  Define a plane between pancreas and the portal vein.

   9.  The distal stomach, extrahepatic biliary tract.

10.  The distal stomach, the distal common bile duct, and the neck of the pancreas are resected.

11.  The proximal end of the jejunum is anastomosed to the distal pancreas.

12.  The common bile duct is anastomosed to the jejunum in end-to-side fashion.

13.  The distal stomach is anastomosed to the jejunum also in end-to-side fashion.

14.  The wound is drained.

15.  The abdomen is closed in layers.

Instruments

•   General set

•   Biliary tract set

•   Gastrointestinal set

•   Deep instruments set (available)

•   Harringtom retractors (Fig. 9.26)

•           Hemoclip appliers (variety of sizes and lengths) (Fig. 17.25)

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