| Pancreaticoduodenectomy (also called a Whipple procedure) refers to the surgical removal of part of the common bile duct, the gallbladder, the duodenum, the pancreas down to its middle section, and sometimes part of the stomach. The lymph nodes that surround these organs are removed in the presence of a malignancy. The middle part of the small intestine (jejunum) is then attached to the remaining parts of the pancreas and bile duct so that pancreatic secretions (digestive enzymes) and bile still flow into the intestinal tract. Pancreatic cancer must be relatively confined. Even then, only 20% of cancers of the head of the pancreas are resectable (Way 645).
Diseases that put an individual at risk for needing pancreaticoduodenectomy are pancreatic cancer, tumor of the bile duct, inflammation of the pancreas (pancreatitis), chronic pancreatitis, pancreatic trauma, and pancreatic cysts. |
Source: Medical Disability Advisor
| Pancreaticoduodenectomy is performed to remove diseased pancreatic tissue and to relieve the severe pain produced by these diseases.
Pancreaticoduodenectomy is used to treat localized pancreatic cancer, acute or chronic inflammation of the pancreas (pancreatitis) that does not respond to medical treatment, hormone-secreting tumors (insulinomas), cancer of the small chamber formed by the union of the common bile duct and pancreatic duct (ampulla of Vater), pancreatic trauma, and pancreatic cysts. |
Source: Medical Disability Advisor
| Pancreaticoduodenectomy is a major surgical procedure that requires hospitalization. It is performed under general anesthesia, and a urinary catheter is usually inserted to facilitate bladder elimination.
The surgeon makes an incision across and through the upper abdominal wall (wide transverse subcostal approach) to expose the pancreas and other abdominal organs as needed. Most commonly, the head of the pancreas and varying amounts of its neck and body, the gallbladder, the end of the common bile duct, and the upper part of the small intestine (duodenum and proximal 10 centimeters of the jejunum) are removed. Sometimes part of the stomach (distal third with the right half of the greater omentum) and the lymph nodes that surround the pancreas and small intestine (peripancreatic and hepatoduodenal nodes) will also be removed. Blood vessels (arteries, veins) and lymphatic ducts are tied off as these tissues are removed. The surgeon then connects the remaining portion of the pancreas to the small intestine and the remaining bile duct so that the pancreatic duct secretions and bile can empty into the intestinal tract (pancreatojejunostomy). Temporary abdominal drains (Jackson-Pratt and Volker drains) may be put in. Abdominal sutures and drains will be removed on an outpatient basis 2 to 3 weeks after surgery. |
Source: Medical Disability Advisor
| The mortality rate from surgery is 5% when performed by a surgeon who does the procedure regularly. This figure rises to 20% to 30% when less experienced surgeons perform the procedure (Way 646). Morbidity is also common. The postoperative complication producing the most problems is breakdown of the surgical connection (anastomosis) between the small intestine and the pancreas. This occurs in 17% of cases and is fatal nearly 30% of the time.
The average mortality rate 5 years after surgery for individuals who undergo pancreaticoduodenectomy is 10% to 20% if the margins of the resected area are clear of cancer. The overall figure drops to 10% (Way 646). |
Source: Medical Disability Advisor
| For individuals who have had pancreaticoduodenectomy, intermittent positive pressure breathing exercises may be useful in preventing postoperative pulmonary complications. Also, certain exercises may be performed to reduce postoperative pain and speed recovery, including progressive relaxation and deep-breathing techniques. These exercises may be performed several times a day until pain from inhalation and exhalation is less noticeable. Ankle flexes, knee bends, and crossed-leg muscle contractions (all performed while lying on the back) will help to increase circulation and make walking easier. These exercises are especially valuable during the first 48 hours after surgery. |
Source: Medical Disability Advisor
| Complications of pancreaticoduodenectomy may include leakage from the pancreatic duct, abdominal pain, bleeding (hemorrhage), creation of an abnormal channel out of the bile duct (biliary fistula), decreased blood flow to the abdominal tissues (mesenteric ischemia), development of pockets of infection (abscess) within the liver or abdomen, fluid accumulation in the intestine (chylous ascites), puncture of the stomach (gastric perforation), and twisting of the small intestine (jejunal torsion).
The pancreas may become inflamed (acute pancreatitis). An abnormal channel may form through the pancreatic duct (pancreatic fistula) in nearly 2% of cases. Death rarely occurs from either of the latter two complications. |
Source: Medical Disability Advisor
| Individuals will be hospitalized for at least 2 weeks and possibly longer. Subsequent recuperation time at home will also be required. Upon return to work, individuals will require more sedentary work for a period of time due to weakness and fatigue following surgery. Medium to heavy-duty responsibilities should be postponed. |
Source: Medical Disability Advisor
| Way, L. W., and Gerald M. Doherty, eds. "Pancreas." Current Surgical Diagnosis & Treatment. 11th ed. New York: McGraw-Hill, 2004. 625-651. |
Source: Medical Disability Advisor