Pancreaticoduodenectomy (Whipple Procedure)
Pancreaticoduodenectomy is also called Whipple or Kausch-Whipple procedure. This procedure is performed for cancer of the pancreatic head, tumors of the common bile duct, duodenal papilla and ampulla. The procedure involves surgical removal of head of the pancreas, part of the duodenum, the gallbladder, pylorus which is a portion of the stomach and the lymph nodes located near the head of the pancreas. The end of a patient’s bile duct and the remaining pancreas are then connected to the small bowel to ensure flow of bile and enzymes into the intestines.
Indicated for tumors in the body and tail of the pancreas, a distal pancreatectomy involves the removal of neoplasms either laparoscopically or with open surgery. With both laparoscopic and open distal pancreatectomy procedures, surgeons attempt to preserve the spleen. Distal pancreatectomy attempts to remove the bottom half of the pancreas due to the presence of a tumor in the tail of the pancreas. Once removed the edge of the pancreas is sutured to avoid leakage of pancreatic juices. There are at least three different techniques for distal pancreatectomy which are open distal pancreatectomy and splenectomy, spleen preserving distal pancreatectomy and laparoscopic distal pancreatectomy.
- Open distal pancreatectomy and splenectomy The blood supply of the spleen is closely associated with the pancreas. Open distal pancreatectomy and splenectomy involves complete removal of the spleen along with the tail of the pancreas.
- Spleen preserving distal pancreatectomy The blood vessels in the spleen are responsible for supplying blood to the pancreas. In an attempt to preserve this process, the blood vessels are carefully separated from the pancreas and the tail of the pancreas is then removed.
- Laparoscopuc distal pancreatectomy This procedure is recommended for people suffering from pseudocysts or chronic pancreatitis, islet cell tumors of the pancreas or cystic tumors in the pancreas. A laparoscopic hand access device is utilized with an incision of about just 2.5 inches. The specialty of the device enables the surgeon to insert their hand into the abdomen during the surgery.
With chronic pancreatitis, a dilated pancreatic duct usually reflects obstruction. Quite often these patients present with stones in the pancreas. In chronic pancreatitis, there is progressive pancreatic fibrosis and subsequent loss of exocrine and endocrine functions. Surgical intervention is warranted for patients with intractable pain that does not respond to non-surgical therapy. Otherwise considered benign, chronic pancreatitis can affect the quality of life in an individual causing significant distress.
Procedures to improve ductal drainage include:
Longitudinal Pancreaticojejunostomy (Puestow Procedure)
A longitudinal incision is made in the pancreas. The pancreatic duct is opened from the tail to the head of the pancreas and attached to the small bowel. The duct and the pancreas are then sewn together to the pancreatic duct to allow drainage.
Distal Pancreaticojejunostomy (Du Val Procedure)
The pancreas is divided transversely at the neck, and the body and tail are drained via attachment to the small bowel. A termino-lateral Pancreaticojejunostomy will enable resection of the pancreatic tail and retrograde drainage of the pancreatic duct. The pancreatic duct is then decompressed.
When endoscopic sphincterotomy is unsuccessful, surgical transduodenal sphincteroplasty may be required of the minor or major papilla. It is an open surgery under general anesthesia.