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Pa n creaticoduodenectomy The Whipple Procedure

By Preston Paynter and Brielle Bowyer. Pa n creaticoduodenectomy The Whipple Procedure. Reasons for Procedure. Pancreatic Cancer Chronic Pancreatitis Severe trauma to the Pancreas. Diagnostic Procedures. CT scan Needle biopsy Cholangiopancreatography Endoscopic ultrasound

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Pa n creaticoduodenectomy The Whipple Procedure

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  1. By Preston Paynter and Brielle Bowyer PancreaticoduodenectomyThe Whipple Procedure

  2. Reasons for Procedure • Pancreatic Cancer • Chronic Pancreatitis • Severe trauma to the Pancreas

  3. Diagnostic Procedures • CT scan • Needle biopsy • Cholangiopancreatography • Endoscopic ultrasound • Palpation of the pancreas

  4. Procedure Summary • Resection • Part or all of the pancreas, duodenum, gallbladder, distal stomach and surrounding lymph nodes are identified and removed. • Reconstruction • Attachment of left over stomach, left over pancreas, and common bile duct to the jejunum. ** Class II wound unless spillage occurs.

  5. Supplies and Instrumentation • Supplies • Prep set • Basic pack • Basin set • Blades • #10 • #11 • Laparotomy drapes • Bovie • Suture • Doctors Pref. • Dressing • Doctors Pref. • Hemostatic agents • Suction • Head lamp • Instrumentation • Major instrument set • Vascular instruments • Biliary instruments (in room) • Long instruments • Bowl resection set • Retractors • Hand held • Self Retaining • Ligating clip appliers and clips • Staplers • Drains

  6. Operative Prep • Anesthesia • General • Positioning • Supine with arms on arm boards • Skin Prep • Shave • Begin where incision will be. • Extends from chest to upper thighs and down to the table on both sides • Draping • Lap sheet outlined with towels • Incision • Left Sub-costal or upper midline **Special consideration -Lubricate and protect the patient’s eyes

  7. Operative Procedure Resection • Incision is made • Exploration of the abdomen and assessment of the extent and resectability of the tumor is made. • Cholecystectomy • Removal of Lymph nodes in the surrounding area • Partial Gastrectomy • Vagotomy • Division of the Pancreas • Dissection of the retro-pancreatic vessels • Removal of Duodenum

  8. Operative Procedure Reconstruction • Pancreaticojejunostomy • Hepaticojejunostomy • End-to-side gastrojejunostomy • NG tube placed • Drains placed behind the pacreatic and biliaryanastomoses • Stab wound made on the right side of the abdomen where drain tube exits. • Secured at the skin level with 3-0 silk • Counts take place • 4 total Counts • Abdomen closed

  9. Post-Op • Immediate Postoperative Care • Transport to PACU • Possible Complications • Hemorrhage • Wound Infection • Fistula formation • Recurrence of Pathology • Leakage of Anastomosis • Nutritional/Digestive concerns • Ileus • Prognosis • Depends on response to primary condition • Mortality rate is 5% when surgery is performed by an experienced surgeon.

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