Open ccess ournl of urer had asa class of 3 or above, this prevalence is comparable to that reported in the literature 5. Pancreaticoduodenectomy aftercare instructions what. Pancreaticoduodenectomy pd has become the standard of care for resectable pancreatic cancer and premalignant lesions in the periampullary region. In a prospective, randomised, control trial organ preserving pancreatic head resection opphr was compared with pylorus preserving pancreaticoduodenectomy pppd to assess the advantages and disadvantages of each type of operation. Pancreaticojejuno anastomosis after pancreaticoduodenectomy. The two groups had similar tumor characteristics and received comparable adjuvant treatments. It is important to achieve a good pancreaticenteric anastomosis, because a postoperative pancreatic fistula may lead to major complications, prolonged hospital stay, and mortality 1, 2. Pyloruspreserving pancreaticoduodenectomy pp whipple versus pancreaticoduodenectomy classic whipple for surgical treatment of. In fact, pancreatic cancer is projected to be the second most common cause of cancer deaths by 2030. Pancreaticoduodenectomy pd has become an increasingly common and safe operation for selected patients with benign and malignant periampullary disorders. Pathophysiology after pancreaticoduodenectomy europe pmc. Overall, the fiveyear survival rate after a whipple procedure is about 20 to 25%.
These cancer cells often make too much tissue and affect other nearby structures in the abdomen. In our technique of pancreaticoduodenectomy, we adopted a suprapyloric gastric resection i. The aim of this study was to establish whether the pyloruspreserving pancreatoduodenectomy pppd is a safe and radical procedure in malignant disease of the head of the pancreas and periampullary region, without increased morbidity and mortality rates compared with the standard whipples procedure. Duodenalpreserving resection of the head of the pancreas. Pancreaticoduodenectomy is also called whipple procedure. The advantages of pyloruspreserving pancreatoduodenectomy. Intraoperative photo after resection and vascular reconstruction. Towards achieving mortality free pancreaticoduodenectomy. Pylorus preserving pancreaticoduodenectomy pppd was first popularized by traverso and longmire in 1978. Pancreatic cancer was the 7 th cause of death in china in 20 and the 4 th cause of death in us and the incidence has been increasing. The surgical data, postoperative complications, induction of diabetes.
The majority of pancreatic adenocarcinomas are located within the head, neck, and uncinate process of the pancreas and require a pancreaticoduodenectomy with lymphadenectomy. Several modifications have been reported, including the pylorus preserving pancreaticoduodenectomy pppd described by watson in 1944. Feb 03, 2020 pancreaticoduodenectomy is also called whipple procedure. Abdominal surgery rotation section 7 whipple resection. Pylorus preserving pancreaticoduodenectomy garonzik. Some patients with potentially unresectable disease will undergo staging laparoscopy prior to laparotomy. For chronic pancreatitis, european prospective trials have concluded that duodenum preserving head resections dphr are associated with less morbidity and similar pain relief and quality of life qol outcomes compared with pancreaticoduodenectomy pd. A comparison of pancreaticoduodenectomy with pylorus. Whipple to the new york surgical society and philadelphia academy of surgery at the ny academy of medicine, february 14, 1945a paper that was to change the. The cancer cells grow and divide without control or order. It is also used for the treatment of pancreatic or duodenal trauma, or chronic pancreatitis. In addition to pancreatic anastomotic leaks, 3 reduced blood flow and. Whipple procedure for multiple endocrine neoplasia of the.
A fluid collection seen on ct around the pancreaticojejunostomy site and in the pancreatic bed may be caused by pancreatic fistula in patients who have undergone pancreaticoduodenectomy. Pyloruspreserving pancreaticoduodenectomy pppd is the mainstay of treatment for periampullary lesions. This article is a case series with respect to the 7year experience of the whipple procedure in firoozgar teaching hospital. Some element of delayed gastric emptying affects as many as 46% of patients. Nutrition after your pancreaticoduodenectomy whipple. A pancreaticoduodenectomy, even if it is the pylorus preserving type, appears to be an excessively invasive treatment for removing benign lesions of the head of the pancreas or periampullary region considering the extent of the resection and the resulting operative morbidity. Pancreaticoduodenectomy for pancreatic cancer in jehovahs witness using inferior pancreatoduodenal artery first approach int. Complications of pancreaticoduodenectomy springerlink. Pyloruspreserving whipple resection for pancreatic cancer. Pancreaticoduodenectomy has evolved since kausch performed the first successful procedure as a twostage operation in 1912. We studied cases of pancreaticoduodenectomy pd with pg for pancreatic head and periampullary carci noma in our.
Pancreaticoduodenectomy inpatient care what you need. Pancreaticoduodenectomy aftercare instructions what you. Preservation of the pylorus in pancreaticoduodenectomy has been shown in retrospective studies to lead to a longterm improve. First described in the 1930s, it involves resection of the proximal pancreas, along. Pylorus preserving whipple resection for pancreatic cancer. Procedure performed by john chabot, md, columbia university medical center, new york, ny. O whipple was the first to describe pancreaticoduodenectomy in 1935 as a modified procedure. The advantages of pyloruspreserving pancreatoduodenectomy in. Pancreaticoduodenectomy pd, pyloruspreserving pancreaticoduodenectomy pppd, and duodenumpreserving pancreatic head resection dpphr are important treatment options for patients with chronic. Pylorus preserving pancreaticoduodenectomy versus standard whipple procedure a prospective, randomized, multicenter analysis of 170 patients. Later on, this technique was refined by whipple et al.
A pancreaticoduodenectomy, even if it is the pyloruspreserving type, appears to be an excessively invasive treatment for removing benign lesions of the head of the pancreas or periampullary region considering the extent of the resection and the resulting operative morbidity. Pyloric preservation pp can frequently be performed at the time of pancreatoduodenectomy pd, although some reports have linked it to inferior outcomes such as delayed gastric emptying dge. Pancreaticoduodenectomy for pancreatic cancer in jehovahs. Our objective was to establish the ct features that are indicative of pancreatic fistula after pancreaticoduodenectomy.
The best pancreatic anastomosis technique after pancreaticoduodenectomy pd is still debated. A casematched comparison and metaanalysis comparing. Due to the shared blood supply of organs in the proximal gastrointestinal system, surgical removal of the head of the pancreas also. Diagram showing how the pancreas and bowel is joined back together after a whipples operation cruk 140 az.
We support pancreaticojejuno anastomosis pj advantages describing our technique with brief technical considerations. Prospective randomised comparison of organpreserving. The characteristics of patients undergoing dphr and pd procedures were similar. The incidence of postoperative pancreatic fistula ranges from 2 to more than 20 % after open pancreaticoduodenectomy, and from 1. It is done to remove a tumor lump from the pancreas or bile duct. Definition removal of the head of the pancreas, the very proximal portion of the jejunum, the distal third of the stomach, and the distal half of the common bile duct, with reestablishment of continuity of the biliary, pancreatic, and gastrointestinal tracts. Pylorus preserving pancreaticoduodenectomy pppd leaving the functional pylorus at the gastric outlet was first reported by watson in 1944 6. Feb 03, 2020 pancreaticoduodenectomy is surgery to remove the head of your pancreas, your duodenum, the end of your bile duct, and your gallbladder. Pancreaticoduodenectomy pd is the treatment of choice for various benign and.
Duodenalpreserving resection of the head of the pancreas and. N2 the concept of operations to be as resective as necessary and as organpreserving as possible has led to the novel technique of resection of the entire duodenum, with complete preservation of the head of the pancreas, as a better alternative to the. Several pancreaticenteric anastomosis techniques for lpd have been reported, but most are adaptations of open procedures. Pancreaticoduodenectomy is surgery to remove the head of your pancreas, your duodenum, the end of your bile duct, and your gallbladder. Patient was taken to surgery and underwent standard. No increase in delayed gastric emptying after pyloruspreserving. Pylorus preserving pancreaticoduodenectomy article pdf available in clinical liver disease 53 march 2015 with 276 reads how we measure reads. The objective of this study is to highlight how robotic surgery could improve a minimally invasive approach and to expose the usefulness of robotic surgery even in complex surgical procedures. Pancreaticoduodenectomy inpatient care what you need to know. The procedure is used to treat benign masses or cancers in the head of the pancreas, ampulla of vater, duodenum, common bile duct and sometimes to treat chronic. Two surgical techniques are usually performed in the treatment of pancreatic head cancer. Pancreatoduodenectomy with or without pyloric preservation.
Forty patients were allocated randomly to either the opphr n20 or the pppd n20 group. Abdominal surgery rotation section 7 whipple resection 1. In a prospective, randomised, control trial organpreserving pancreatic head resection opphr was compared with pyloruspreserving pancreaticoduodenectomy pppd to assess the advantages and disadvantages of each type of operation. Specific technique no touch technique discussion the procedure is usually performed for regional malignancy and benign, obstructive, or. This surgery is done when a cancerous tumor has been found in the head of your pancreas. Pyloruspreserving pancreaticoduodenectomy whipple procedure.
Standard classic procedure pylorus preserving procedure jejunum. Eightyone patients underwent either a whipple pd n 59 or a dphr bern, beger or frey procedure, n 22 for the treatment of pain caused by chronic pancreatitis over a 5year period. Robotic pancreaticoduodenectomy in a case of duodenal. Pyloruspreserving pancreaticoduodenectomy cochrane library. Surgical considerations the whipple resection consists of a pancreaticoduodenectomy followed by anastamosis of the pancreas, liver and stomach to the jejunum. A pancreaticoduodenectomy, also known as a whipple procedure, is a major surgical operation most often performed to remove cancerous tumours off the head of the pancreas. Pylorus preserving pancreaticoduodenectomy is an accepted treatment for benign and malignant diseases of the pancreas. It is a surgery in which the head of the pancreas, gallbladder, stomach and part of the small intestine, and the bile duct are removed. Open ccess ournl of urer had asa class of 3 or above, this prevalence is comparable to. Pyloruspreserving pancreaticoduodenectomy pp whipple versus. The incidence of postoperative bacterial infections was significantly lower with synbiotics 12.
Despite being a relatively rare cancer, pancreatic cancer is the third leading cause of cancer death in the united states with over 41,000 patients succumbing to the disease in 2016 alone. Pppd has been performed increasingly for periampullary tumors as a modification of conventional. Risk factors for pancreatogenic diabetes after pancreaticoduodenectomy. Pancreatic fistula pf is the most important complication but is also related to postoperative bleedings and pancreatic remnant involution. The introduction of partial pancreaticoduodenectomy is credited to godivilla, an italian surgeon, and kausch, a german surgeon from berlin. Endtoend reconstruction of the lateral trunk of smv is marked. Resection of the 3rd 4th duodenal portion with resection of treitz and 1st 2nd jejunal limb and rese duration. The whipple procedure, or pancreaticoduodenectomy, is the most common operation performed to treat pancreatic masses and offers the best chance for long term control of disease. The operative mortality rates reported for many highvolume pancreatic surgical centers are now less than 5%, a dramatic improvement over the rate of 20% often reported during the 1970s.
Case 1 a 74yearold female underwent a pylorus preserving pancreaticoduodenectomy pppd for a tumor of the head of the pancreas. Many radiology reports have described postoperative changes and complications after pancreaticoduodenectomy 9. During 1990 to 1997 a series of 39 patients underwent a classic pancreaticoduodenectomy and 74 a pyloruspreserving pancreaticoduodenectomy for pancreatic adenocarcinoma. Background some background information regarding pyloruspreserving pancreaticoduodenectomy pppd, also commonly referred to as the whipple procedure, is provided below. For orientation of pds, identification of the trapezoid, created by the vascular bed at the center, the pancreatic neck margin on the left, and the uncinate margin on the right, is of outmost importance in finding all the pertinent margins of the specimen including the cbd, which is located at the upper. Conventional vs pyloruspreserving pancreaticoduodenectomy with. Pancreaticoduodenectomy an overview sciencedirect topics. Your surgeon will decide on whether to carry out a.
Approximately 75% of all pancreatic cancers arise in the head of the pancreas. Pyloruspreserving pancreaticoduodenectomy with complete. Apr 03, 2020 the introduction of partial pancreaticoduodenectomy is credited to godivilla, an italian surgeon, and kausch, a german surgeon from berlin. Please rate this residents performance during this operative procedure. About pancreatic surgery pdf, 461kb oxford university hospitals. However, there is some clinical evidence to support these experiments and hypotheses. Minimal invasive surgery has been proven with the advantages of less blood loss, early recovery, better cosmesis and even longer progressionfree survival. Pdf risk factors for pancreatogenic diabetes after. Media in category pancreaticoduodenectomy the following 4 files are in this category, out of 4 total. A pancreaticoduodenectomy is also known as the whipple procedure.
Also called a pancreaticoduodenectomy, the whipple procedure is performed to address chronic pancreatitis and cancer of the pancreas, ampulla of vater, duodenum, and the distal bile duct. Pylorus preserving pancreaticoduodenectomy versus standard. Case 1 a 74yearold female underwent a pyloruspreserving pancreaticoduodenectomy pppd for a tumor of the head of the pancreas. Laparoscopic pancreaticoduodenectomy is rarely performed, and it has not been particularly successful due to its technical complexity. Even if the procedure successfully removes the visible tumor, it. A modification of the conventional procedure, pyloruspreserving pancreaticoduodenectomy preserves the gastric antrum, pylorus, and the proximal 2 to 3 cm. Abstract pyloruspreserving pancreaticoduodenectomy. Pancreatic cancer is generally found in the older population pancreaticoduodenectomy seems to be the only way in resolving these resectable tumors. The aim of this study was to establish whether the pylorus preserving pancreatoduodenectomy pppd is a safe and radical procedure in malignant disease of the head of the pancreas and periampullary region, without increased morbidity and mortality rates compared with the standard whipples procedure. Although many surgical procedures are now routinely performed laparoscopically, pure laparoscopic pancreaticoduodenectomy lpd is not commonly performed because of the technical difficulty of pancreatic resection and the associated reconstruction procedures.
A prospective randomized multicenter study was performed to assess whether the results of pylorus preserving pancreaticoduodenectomy pppd equal those of the standard whipple sw operation, especially with respect to duration of surgery, blood loss, hospital stay, delayed gastric emptying dge, and survival. Jul 30, 2015 resection of the 3rd 4th duodenal portion with resection of treitz and 1st 2nd jejunal limb and rese duration. Several modifications have been reported, including the pyloruspreserving pancreaticoduodenectomy pppd described by watson in 1944. Pancreaticoduodenectomy whipple procedure evaluator. The classic kauschwhipple pancreaticoduodenectomy pd has the wellknown side effects of a partial gastric resection such as early and late dumping and postoperative weight loss. Ct features of pancreatic fistula after pancreaticoduodenectomy. Pyloruspreserving pd versus classic whipple procedure. Pylorus preserving pancreaticoduodenectomy jacqueline m.
Differences between pppd and pd groups included cancer. Nov 09, 2018 pyloruspreserving pancreaticoduodenectomy whipple procedure. Naritomi et al evaluated the first occurrence of mmc and motilin in patients with pyloruspreserving pancreaticoduodenectomy pppd and duodenumpreserving pancreatic head resection dpphr. Feature pylorus preserving pancreaticoduodenectomy versus standard whipple procedure a prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors. Pancreaticoduodenectomy pd, pylorus preserving pancreaticoduodenectomy pppd, and duodenum preserving pancreatic head resection dpphr are important treatment options for patients with chronic. Pancreaticoduodenectomy for islet carcinoma a five year followup was the title of a presentation by dr allen o.
A modification of the conventional procedure, pylorus preserving pancreaticoduodenectomy preserves the gastric antrum, pylorus, and the proximal 2 to 3 cm. During 1990 to 1997 a series of 39 patients underwent a classic pancreaticoduodenectomy and 74 a pylorus preserving pancreaticoduodenectomy for pancreatic adenocarcinoma. Radical resection is the only way currently available to get cure for these patients. The effect of enteral nutrition and synbiotics versus prebiotic fibre on bacterial infection rates after pylorus preserving pancreaticoduodenectomy was evaluated in a prospective randomized doubleblind trial in 80 patients rayes et al. Tran kt, 2004, pylorus preserving pancreaticoduodenectomy versus standard whipple procedure. Pylorus preserving pancreaticoduodenectomy pp whipple versus pancreaticoduodenectomy classic whipple for surgical treatment of periampullary and pancreatic carcinoma markus k diener, 1 christina fitzmaurice, 2 guido schwarzer, 3 christoph m seiler, 1 felix j huttner, 1 gerd antes, 4 hannspeter knaebel, 5 and markus w buchler 1. Please rate this residents performance during this. Management of pancreatic fistulas after pancreaticoduodenectomy. Conventional pancreaticoduodenectomy involves a distal gastrectomy with removal of the pancreatic head, duodenum, first 15 cm of the jejunum, common bile duct, and gallbladder figure 1.
Majella doyle pancreaticoduodenectomy pd has become the standard of care for resectable pancreatic cancer and premalignant lesions in the periampullary region. In most institutions, ct is performed for evaluating tumor recurrence and complications after pancreaticoduodenectomy. A pancreatic or bile duct tumor forms when cells become cancer. Fourth floor san francisco, ca 94115 415 8857404 new patient appointments 415 3537687 main phone 415 3537781 fax. Pyloruspreserving pancreaticoduodenectomy pp whipple.
1320 341 384 1510 539 322 20 910 1024 373 376 1153 919 251 1127 746 1010 1590 1172 1563 652 1612 976 1280 460 799 1123 735 706 1173 1011 1122