An italian surgeon, alessandro codivilla, was the first to perform a pancreaticoduodenectomy. Pancreatic cancer has been in the public eye lately because it has afflicted several prominent people, including supreme court justice ruth bader ginsburg, apple ceo steve jobs, actor patrick swayze, and randy pausch, a computer science professor at carnegie mellon university whose inspirational last lecture became a youtube sensation and, as a. Operative technique in robotic pancreaticoduodenectomy. Despite advances in surgical technique and postoperative care, the procedure continues to. Whipples procedure or pancreaticoduodenectomy has been performed safely for many years, and has evolved consistently, including changes in pre and postoperative management, changes in the surgical technique and changes in approach. Nov 09, 2018 pyloruspreserving pancreaticoduodenectomy whipple procedure. Pancreaticoduodenectomy whipple s procedure remains the only definitive treatment option for tumors of the periampullary region. This is an extensive and difficult surgery that is intended to eradicate the entire malignant cells or cancer cells. These indications are not reserved only to whipple operation, but to. Pdf objectives pancreaticoduedenectomy or whipple procedure remains the procedure of choice that obtains long survival in pancreatichead cancer.
Vascular resections during the whipple procedure advances. Both of these surgeries involve resection of the pancreatic head, neck, and uncinate process as well as the duodenum, gallbladder, distal bile duct, and proximal jejunum. The whipple procedure is done using one large incision surgical cut in the abdomen. Below are some common problems people have after surgery. Few studies have been published describing the benefits of wrapping the omentum around the anastomosis. During this procedure, surgeons remove the head of the pancreas, most of the duodenum a part of the small intestine, a portion of the bile. Pancreatic anatomy, surgical technique, indications for the procedure and also the results of a study.
Pancreatic cancer is the fourth cause of death from cancer in western countries. The first resection for a periampullary cancer was performed by the. Pyloruspreserving pancreaticoduodenectomy whipple procedure. The presence of celiac artery stenosis should be determined preoperatively by carefully assessing the sagittal images see fig. The operation is divided into six clearly defined steps to allow safe removal of the pancreatic head, distal stomach, duodenum, bile duct and gallbladder. Pancreaticoduodenectomy has evolved since kausch performed the first successful procedure as a twostage operation in 1912. The whipple removes and reconstructs a large part of the. The whipple procedure is used to treat four types of cancer periampullary, cholangiocarcinoma, duodenal, and pancreatic ductal. The whipple procedure is the most common surgery used to remove cancer from the pancreas. Jan 03, 20 the type of operation performed for removal of pancreatic cancer is based on the location of the tumor. Sometimes, before making the large incision, the surgeon will make several small incisions and put a small video camera into the abdomen.
Learn vocabulary, terms, and more with flashcards, games, and other study tools. Mar, 2019 immediately after the whipple procedure, serious complications can affect many patients. Whipple s procedure how to do pancreaticoduodenectomy by surgical oncologist. Whipple procedure pancreaticoduodenectomy pancreatic. They use this camera to look at the organs to see if the cancer has spread outside of the. Even if the procedure successfully removes the visible tumor, it. Illustration of the six step pancreaticoduodenectomy.
This operation, whether performed as a classic whipple procedure or as a pyloruspreserving variation, should incur a. A reasonable level of experience with major pancreatic resection necessary to achieve good results. Surgical considerations the whipple resection consists of a pancreaticoduodenectomy followed by anastamosis of the pancreas, liver and stomach to the jejunum. A simple and lucid explanation and techniques of operative procedures in gi surgery. First laparoscopic whipple s procedure was done in 1994. Outline for whipple procedure for carcinoma of the pancreas part 1. The aim of the study is to propose a new technique of reconstruction after pancreaticoduodenectomy with more attention to the functional aspects. Minimally invasive techniques for laparoscopic whipple procedures are feasible and safe. For both versions of the pd, the proximal jejunum is transected approximately 5 to 10 cm distal to the ligament of treitz. Than allen o whipple modified this procedure in 1935, but the complexity of technique and the associated high morbidity and mortality resulted in initial reluctance to adopt this surgery for the management of pancreatic and periampullary tumors. The whipple procedure affects part of the digestive tract, which changes the way meals are. Advances in surgical technique, anesthesia and hospital care have resulted in a 30day inhospital mortality rate of. The classic whipple procedure and the pyloruspreserving whipple procedure have similar morbidity and mortality 4. Pancreaticoduodenectomy has evolved since kausch performed the first successful procedure.
As a result of widespread abdominal imaging, more early stage pancreatic cancers are being diagnosed, and these patients are candidates for a pancreaticoduodenectomy, more commonly known as the whipple procedure. The whipple procedure also called a pancreaticoduodenectomy is the primary surgical treatment for pancreatic cancer that occurs within the head of the gland. Pancreaticoduodenectomy with pancreaticogastrostomy by montenegros technique. Equally ambiguous are the impacts of robotassisted and laparoscopic techniques for whipple surgery. Some patients with potentially unresectable disease will undergo staging laparoscopy prior to laparotomy. The type of operation performed for removal of pancreatic cancer is based on the location of the tumor. This operation was done in two stages and over a period of 70 years the.
This is because the pancreas and a part of the small intestine and sometimes, stomach are removed during the procedure. The radical surgical resection is the only curative. This video demonstrates laparoscopic whipple in patient with iwith previous. End of part one part 2 video to cover remaining steps. However whipple disease was named for a different dr whipple. Thus, for a pyloruspreserving operation, 1 to 2 cm of the duodenum is preserved, whereas the entire duodenum is removed during a classic whipple procedure. Horacio asbun, mayo clinic in florida, explains the whipple procedure using this animated graphic of a pancreas. Our usual anaesthetic technique for pancreatic surgery is a combination of general and epidural anaesthesia. On the basis of analytical data, we conclude that the superior approach technique is effective for pd compared with the classical whipple s technique. Best known for its use in the treatment of pancreatic cancer, the procedure has a success rate of 7080 percent in treating chronic pancreatitis. For tumors of the head and neck of the pancreas a whipple procedure, also called a. Allen oldfather whipple, the surgeon who designed and first performed this surgical technique in 1935, the whipple procedure has continually improved over the years and can potentially enhance outcomes and quality of life for patients with pancreatic cancer. The procedure removes the head of the pancreas, duodenum, gallbladder and part of the bile duct. The whipple procedure pancreatoduodenectomy encompasses several surgical procedures in the same operation.
The classic whipple procedure is named after allen whipple, md, a columbia university surgeon who was the first american to perform the operation in 1935. Cancer of the pancreas affects 45,000 people every year in the u. Originally performed in a twostep process, whipple refined his technique in 1940 into a onestep operation. Whipple pancreaticoduodenectomy pd is not performed exclusively for. Pdf alternative reconstruction after pancreaticoduodenectomy. Whipple s procedure in the whipple s operation the head of the pancreas, lower quarter of the stomach, common bile duct, gallbladder. This will help you heal faster and prevent infection. Before performing the whipple procedure, the preoperative ct or mri scan should be carefully examined for variant arterial anatomy, as previously discussed. The most common and lifethreatening complications following the procedure are pancreatic anastomotic leakage and subsequent fistula formation. Keywords robotic pancreaticoduodenectomy whipple procedure evidencebased surgery pancreatic surgery uncinate process pancreatic cancer.
Procedure performed by john chabot, md, columbia university medical center, new york, ny. Laparoscopic whipple in roux en y gastric bypass anatomy. The state of pancreatic surgery when whipple published his first series of the twostage procedure in 1935, was as whipple was to comment in. The whipple procedure, or pancreaticoduodenectomy, is the most common surgery to remove tumors in the pancreas. Laparoscopic pancreatic surgery is one of the most advanced technique in minimal invasive surgery. Under general anesthesia, the patient is placed in a supine position with the legs abducted. This procedure was originally described by alessandro codivilla in 1898 and kausch in 1912, and later perfected by allen oldfather whipple in the 1930s. With increasing obesity even though number of bariatric surgeriers are not increasing but prevelance is high. The whipple procedure johns hopkins medicine youtube. It is also used for the treatment of pancreatic or duodenal trauma, or chronic pancreatitis.
Pancreaticoduodenectomy, also referred to as the whipple or kauschwhipple procedure, is the most common surgical procedure for the resection of tumors in the pancreatic head, uncinate process, and neck as well as lesions of the ampulla, extrahepatic bile duct, and duodenum. Whipples procedure, also known as pancreaticodudectomy, is a demanding procedure as it requires the patient to follow a strict diet after the surgery. Case report allen oldfather whipple is a name that will be forever eponymously associated with pancreaticoduodenectomy for pancreatic cancer. Background some background information regarding pyloruspreserving pancreaticoduodenectomy pppd, also commonly referred to as the whipple procedure, is provided below. Notably, however, laparoscopic whipple procedures are still uncommonly used, particularly in cases of pancreatic adenocarcinoma 46. Whipple procedure survival rate, complications, prognosis.
Whipple procedure chronic pancreatitis surgery musc ddc. The radical surgical resection is the only curative option for this. This operation was done in two stages and over a period of 70 years the operative mortality has decreased from 2030%. Pancreaticoduodenectomy an overview sciencedirect topics. The whipple procedure is a possible choice for patients who have pancreatic cancer but only if the cancer has not spread past the pancreas. Pdf robotic whipple procedure for pancreatic cancer. Pancreaticoduodenectomy whipple procedure is commonly performed using two different surgical variants. The whipple procedure pancreaticoduodenectomy is an operation to remove the head of the pancreas, the first part of the small intestine duodenum, the gallbladder and the bile duct. Objectives pancreaticoduedenectomy or whipple procedure remains the procedure of choice that obtains long survival in pancreatichead cancer. Illustration of the sixstep pancreaticoduodenectomy whipple operation as described in a number of recent text books by dr. Whipple procedure pancreaticoduodenectomy rogel cancer. Jul 11, 2019 mayo clinic researchers conduct studies and clinical trials to improve whipple procedures and other approaches to pancreatic cancer. Laparoscopic whipple procedure linked to more deadly. During this procedure, surgeons remove the head of the pancreas, most of the duodenum a part.
The whipple procedure has been used increasingly over the years in treating pain and other complications of chronic pancreatitis. A whipple procedure, or pancreaticoduodenectomy, is the most common type of surgery performed to address pancreatic tumors. General guidelines for at least 6 weeks after your surgery, there are two things you must avoid. It allows fast, safe and virtually bloodless dissection for exposure of the superior mesenteric and portal veins during early steps of pd. A 5 french pediatric feeding tube can be used as a pancreatic duct stent when closing a twolayered endtoside pancreaticojejunostomy. Whipple procedure for carcinoma of the pancreas part 1. Pancreatic anatomy, surgical technique, indications for the procedure. Its normal to have a lack of appetite after the surgery which may cause weight loss.
Abdominal surgery rotation section 7 whipple resection 1. Pancreaticoduodenectomy is the procedure of choice for tumors of the head of the pancreas and periampulla. Carbon dioxide pneumoperitoneum is established using an open technique. Although several case series of the robotic whipple procedure have been reported, detailed descriptions of operative techniques and a clear pathway for adopting this technology are lacking. Using modern operating techniques, mortality from a whipple procedure is around 5%. Nutrition after a whipple procedure home uw health. The whipple procedure and also the triad of whipple were both named after the american surgeon, allen oldfather whipple 18811963 6. Reconstruction after pancreaticoduodenectomy, or whipple s procedure, for patients with an inflammatory mass in the head of the pancreas. It also removes the duodenum, the pylorus lower part of the stomach, the gallbladder and part of the common bile duct. Studies have found similar outcomes between traditional and laparoscopic techniques, with. Mayo clinic is a leader in the minimally invasive laparoscopic approach to the whipple procedure and is one of the few medical centers offering it. The whipple resection consists of a pancreaticoduodenectomy followed by anastamosis of the. Abdominal precautions protecting your incision while you heal after surgery in your stomach or belly area, you must protect your incision the surgery wound. A modified whipple procedure removes all of the same organs except for the pylorus.
A pancreaticoduodenectomy, pancreatoduodenectomy, whipple procedure, or kausch whipple procedure is a major surgical operation most often performed to remove cancerous tumours off the head of the pancreas. Whipple s procedure or pancreaticoduodenectomy has been performed safely for many years, and has evolved consistently, including changes in pre and postoperative management, changes in the surgical technique and changes in approach. Department of hepatobiliary and pancreatic surgery about. Patient selection, preoperative medical evaluation, surgical technique and postoperative care are all critically important in minimizing patient morbidity and mortality and optimizing longterm oncologic outcome. Laparoscopic whipple procedure linked to more deadly complications. The whipple procedure removes a pancreatic tumour, tissue around the tumour, and parts of the pancreas. The actual whipple procedure can take 45 hours, or up to 8 hours if the tissue. A pancreaticoduodenectomy, pancreatoduodenectomy, whipple procedure, or kausch whipple procedure is a major surgical operation most often performed to remove. Omental roll up technique in pancreaticojejunostomy in. The 2layered endtoside laparoscopic pancreatojejunostomy has a low rate of pancreatic fistula formation and may be ideal for laparoscopically created pancreatic anastomoses.
Download a full set of images and illustrations in a pdf document that describes the operation in detail. Vollmer discusses pancreatic cancer and its current surgical techniques and treatments, including the whipple procedure, neoadjuvant therapies, as well as the benefits of the multidisciplinary team approach at penn medicine to ensure. This operation, whether performed as a classic whipple procedure or as a pyloruspreserving variation, should incur a 30day inhospital mortality rate of less than 5%. When these complications occur, treatment strategy depends on the severity of anastomotic leakage, with patients. This operation, whether performed as a classic whipple procedure or as a. Randomizedcontrolled trials with the application of a standardized technique are necessary to better define the role of rpd.
Surgery to remove a tumor offers the best chance for longterm control of all pancreatic cancer types. You are put completely to sleep, and a tube is put into your windpipe, so it is. Such techniques are being used more often, but remain a small fraction of the overall number of pancreatic cancer surgeries performed in the united states. Pancreatic whipple procedure guidelines sarah cannon. This is when the stomach empties slowly after a meal. Renewed uptake of this technique, if considered in the future, should include very.
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