Pancreaticoduodenectomy

Originally described by Alessandro Codivilla in 1898 and Kausch in 1912; and perfected by Allen Oldfather Whipplein the 1930s, pancreaticoduodenectomy is the operation of choice for the management of tumours of the head of the pancreas(the most common site of pancreatic cancer). The basic concept behind the pancreaticoduodenectomy is that the head of the pancreas and the duodenum share the same arterial blood supply, and these arteries run through the head of the pancreas, so that both organs must be removed. To remove only the head of the pancreas would compromise blood flow to the duodenum.

The most common technique of pancreaticoduodenectomy, commonly designated the Whipple (or Kausch-Whipple) procedure consists of the en bloc removal of the distal segment (antrum) of the stomach; the first and second portions of the duodenum; the head of the pancreas; the common bile duct; and the gallbladder.

Some authors advocate the removal of the whole pancreas (total pancreatectomy) instead of just the head. However, clinical trials have failed to demonstrate significant survival benefits, mostly because patients who submit to this operation tend to develop a particularly virulent form of diabetes(so-called brittle diabetes).

More recently, the pylorus-sparing pancreaticoduodenectomy (a.k.a. Traverso-Longmire procedure) is growing increasingly popular, especially among European surgeons. The main advantage of this technique is that the pylorus, and thus normal gastric emptying, is preserved. However, some doubts remain on whether it is an adequate operation from an oncologicalpoint of view.

Another controversial point is whether patients benefit from retroperitoneallymphadenectomy.

Pancreaticoduodenectomy is considered, by any standard, a major surgical procedure. In some hospitals, it carries a terrible reputation for high rates of morbidityand mortality. However, clinical trialsdemonstrate that it is a safe procedure in the hands of experienced surgeonsin high-volume centres.

See also

• Whipple procedure

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It uses material from the http://en.wikipedia.org/wiki/Pancreaticoduodenectomy Wikipedia article Pancreaticoduodenectomy.