Pancreaticoduodenectomy (Whipple Procedure)

Procedure Snapshot

• Indication: Resectable pancreatic head or periampullary malignancy.
• Expected duration: 6–10 h.
• Special instruments: Vascular clamps, staplers, biliary set, retractor.

Step Workflow

1. Midline incision; explore for metastasis.
2. Kocher maneuver for duodenal mobilization.
3. Divide stomach (antrectomy) or duodenum (pylorus-preserving).
4. Transect CBD above cystic junction; divide pancreatic neck over PV/SMV.
5. Remove specimen en bloc (GB, duodenum, pancreatic head).
6. Reconstruct: pancreaticojejunostomy → hepaticojejunostomy → gastrojejunostomy.

Key Pimp Questions

• Q: Mortality at high-volume centers? < 3 % (PMID 32659392).
• Q: Most serious complication? Pancreatic fistula (PMID 33012357).

Critical Anatomy

• Landmarks: SMV/PV confluence, GDA, CBD, pancreatic neck.
• Danger zones: Portal vein, SMA, hepatic artery.

Informed Consent Highlights

• Leak __ Delayed gastric emptying __ Bleeding __ Mortality __

Post-op Considerations

• ICU monitoring; drains for amylase; octreotide PRN.

References

• Chassin’s, Pancreas section. Clinical Scenarios, Hepatobiliary.
• Cameron 2020 (PMID 32659392); Bassi 2020 (PMID 33012357).