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)
Any questions be sent o drmmkapur@gmail.com
All older posts are stored in aechives for access and review.
Visitors that follow may post contributions,please write to address above.
To create consumer/provider engagement visit www.surginstruatlas.blogspot.com
www.surgseminar.blogspot.com www.drmmkapur.blogspot.com
