Whipple who was the first in the united states to describe the procedure. 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. With increasing frequency, whipple is indicated for the risk of malignancy associated with the presence of a cystic neoplasm with worrisome features. Citeseerx document details isaac councill, lee giles, pradeep teregowda. These organs are located in the back of your abdomen belly behind your stomach and just above your small intestine see figure 1. The primary goal of every operation was en bloc r0 tumor resection. Pppd had advantages over prpd in operating time, intraoperative blood loss and. Pancreatoduodenectomy the whipple procedure pancreatoduodenectomy is commonly referred to as the whipple procedure and is named after allan whipple, md, a physician who perfected the surgery in the 1930s.
Pppd and the classical whipple procedure pd in shortterm postoperative course. Whipples operation definition of whipples operation by. General surgery whipple procedure pancreaticoduodenectomy. The whipple procedure was successful in removing the tumor, but also took of the stomach and of the pancreas, duodenum, gall bladder, etc. Whipple procedure definition of whipple procedure by. All patients underwent standard regional lymphadenectomy, which included resection of nodes within the outlines of the hepatoduodenal ligament, the right side of the superior mesenteric artery and the inferior vena cava. Citeseerx standard whipples operation versus pylorus. The choice depends on the surgeons preference and on oncological factors, such as the proximity of the tumour to the duodenum. Your surgeon must also remove the first part of your small intestine bowel, your gallbladder which stores bile and part of your bile duct. Reconstruction after pancreaticoduodenectomy, or whipple s procedure, for patients with an inflammatory mass in the head of the pancreas. It takes the name whipple from the new york surgeon allen o. During the surgery, the head of the pancreas, along with sections of the stomach and small intestines, as well. The whipple removes and reconstructs a large part of the gastrointestinal tract and is a difficult and complex operation. Patients weights were evaluated in the preillness phase, before operation and during four postoperative phases at 3, 7, 11 and 15 months.
Due to the shared blood supply of organs in the proximal gastrointestinal system, surgical removal of the head of. It affects from 1060% of patients,1,2,3,5 and is the largest contributing factor to postoperative morbidity. The head resection surgeries analyzed in the study included 69. Simple whipple pancreaticoduodenectomy pppd flashcards. Allen whipple, a columbia university surgeon who was the first american to perform the operation in 1935. The whipple procedure is done to remove a tumor in the head of your pancreas, your ampulla, or the first part of your duodenum. This procedure is associated with significant postoperative morbidity, rates. Mar, 2019 the classic whipple procedure is named after allen whipple, md, a columbia university surgeon who was the first american to perform the operation in 1935. The outcomes and complications of pancreaticoduodenectomy. The primary goal of every operation was en bloc r0.
The whipple procedure, or a pancreaticoduodenectomy, is a surgery used to treat cancer which involves the head of the pancreas. Between january 2000 and december 2004, 27 patients with pancreatic or. The whipple procedure is the most common operation used to treat pancreatic cancer, and involves removing the head of the pancreas. Pylorus preserving pancreatoduodectomy pppd the pylorus preserving pancreatoduodectomy pppd is a modified whipple s procedure. In the patients who had pppd, median operating time was 232 range 165270 min, and median blood loss was 375 range 1000 ml. A prospective randomized multicenter study was performed to assess whether the results of pyloruspreserving 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. The type of operation performed for removal of pancreatic cancer is based on the location of the tumor. No difference in operative mortality was found, but. Between january 2000 and december 2004, 27 patients with pancreatic or periampullary adenocarcinoma were enrolled into the study. Grahams story he had a whipples operation to treat. Pancreaticoduodenectomy an overview sciencedirect topics.
Nov 09, 2018 background some background information regarding pyloruspreserving pancreaticoduodenectomy pppd, also commonly referred to as the whipple procedure, is provided below. Pancreatic cancer patients who have had the whipple procedure and their spousescaregivers. For tumors of the head and neck of the pancreas a whipple procedure, also called a. He reported three cases, with one perioperative death, one patient dying at 8 months from cholangitis and the third patient surviving 28 months eventually dying of liver metastases. Throughout the hospital stay, the overall weight loss is about 4 to 5 kg only.
The date was set, about 8 weeks from the initial diagnosis scan. In whipples series, the mortality rate was higher than. This is a major surgical operation involving the pancreas, duodenum, and. Pppd versus whipple procedure article in hepatogastroenterology 5265. The whipple procedure is a standard operation performed in operable cancers of the head, neck and the uncinate process of the pancreas. Whipple complication free download as powerpoint presentation. Far less frequently, the procedure is carried out to manage intractable pain associated with a chronic calcific pancreatitis or for massive trauma when there has been irreparable burst. The whipple procedure removes a pancreatic tumour, tissue around the tumour, and parts of the pancreas. Browse more than 12,000 surgery videos and save your favorites for free. The whipple operation is called a pancreaticoduodenectomy in medical terms. The classic technique of pd consists of the enbloc removal of the distal segment of the stomach antrum, the first and the second portions of the duodenum, s. Ppt pancreaticoduodenectomy powerpoint presentation. 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. The whipple procedure johns hopkins medicine youtube.
Sometimes, before making the large incision, the surgeon will make several small incisions and put a small video camera into the abdomen. Enjoying life after whipple procedure for pancreatic cancer. The operation most often performed is called a pancreatoduodenectomy, or more colloquially a whipple procedure, named after dr. Pdf delayed gastric emptying is associated with pylorus. The decision for one of the approaches either whipple or pppd was made during the operation. The whipple procedure is done using one large incision surgical cut in the abdomen. Background the aim of this metaanalysis was to compare the longterm survival, mortality, morbidity and the operationrelated events in patients with periampullary and pancreatic carcinoma undergoing pyloruspreserving pancreaticoduodenectomy pppd and pylorusresecting pancreaticoduodenectomy prpd. Mark fraiman, md st joseph medical center liver and pancreas center 27,680 views 11. From 1991 to 1995, 140 patients underwent subtotal pancreatoduodenectomy. Enjoying life after whipple procedure for pancreatic.
A pancreaticoduodenectomy, also known as a whipple procedure, is a major surgical. The conventional operation for removal of lesions from within the head or uncinate process of the pancreas is pancreaticoduodenectomy, also called the whipple procedure. Pancreaticoduodenectomy whipple is the surgical procedure of choice for curative resection of pancreatic head, periampullary, and distal bile duct cancers. The complete guide to eating after whipple surgery cook. It is usually used for tumours in the head or neck of the pancreas that havent spread beyond the pancreas. The whipple procedure is the most common operation to remove pancreatic cancers. Delayed gastric emptying was observed more frequently after pppd than after the whipple procedure, with marginal statistical significance p 0. The classic whipple procedure involves resection of the gastric antrum, but in appropriate patients a pyloruspreserving whipple pppd may be performed, which results in improved postoperative functional outcome.
This retrospective study has been performed on 98 patients who underwent a classic whipple pancreaticoduodenectomy or pylorus preserving pancreaticoduodenectomy pppd for both benign and malignant tumors by the same surgical team in three different hospitals in the sulaimanyah governorate in iraq, from may 2010 to november 2017. Pancreaticoduodenectomy for pancreatic head cancer. Whipple initially published a series of twostage radical pancreaticoduodenectomy in 19353. Method a systematic search of literature databases cochrane library, pubmed, embase and. Jan 03, 20 the type of operation performed for removal of pancreatic cancer is based on the location of the tumor. Close to 70% cancers of pancreas arise from these parts but only about 20% of pancreatic cancer patients are diagnosed at an operable stage. Scribd is the worlds largest social reading and publishing site. Pyloruspreserving pancreaticoduodenectomy whipple procedure.
It is generally used to remove tumors that are confined to the head, or right portion, of the pancreas. Whipple procedure pancreaticoduodenectomy pancreatic. To reduce weight loss, the surgeon put her thru 3 days of ptn feeding preop and then 2 weeks of ptn feeding postop. There was no significant difference between the whipple procedure and pppd for the treatment of pancreatic head cancer in terms of operating time, blood loss, operative mortality and longterm survival. Occasionally a portion of the stomach may also be removed. After removal of these structures, the remaining pancreas, bile duct and the intestine are sutured back into the intestine to direct the gastrointestinal. A modified whipple procedure removes all of the same organs except for the pylorus. Marginal ulceration is a serious problem after both standard pancreaticoduodenectomy pd and pyloruspreserving pancreaticoduodenectomy pppd. The stock whipple kit was putting out 9 lbs of boost right out of the box thats why i forged my internals so quickly after.
Comparison of the stomachpreserving versus classic. There was no significant difference between the whipple procedure and pppd for the treatment of. Another uncertainty is whether the two methods are associated. Perioperative management and anaesthetic considerations. In this case, only part of the duodenum is removed and the pylorus the part of the stomach that connects to the duodenum is kept. Hema slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. A whipple surgery pancreatoduodenectomy is usually performed on pancreatic cancer patients to remove tumors at the head of the pancreas. The remaining organs are reattached to allow you to digest food normally after surgery. Complications after pancreaticoduodenectomy surgical gastroenterology clinics t. I was told that i was a priority for a whipple s operation.
A pancreaticoduodenectomy, pancreatoduodenectomy, whipple procedure, or kausch whipple procedure is a major surgical operation most often performed to remove cancerous tumours off the head of the pancreas. Graham, 49, was diagnosed in 2009 and had a whipple s operation. Surgeon reconnects the remaining pancreas and digestive organs. It is also used for the treatment of pancreatic or duodenal trauma, or chronic pancreatitis. Pancreaticoduodenectomy has evolved since kausch performed the first successful procedure as a twostage operation in 1912. Ppt whipple pancreaticoduodenectomy powerpoint presentation. It is unclear whether the pyloruspreserving whipple procedure results in a higher rate of recurrence of the tumour because it is less extensive and therefore may be less radical, but it is also unknown whether quality of life is decreased after removal of the lower portion of the stomach. Surgery to remove a tumor offers the best chance for longterm control of all pancreatic cancer types. Seiler et al19 found shorter operation time, less blood loss, and fewer blood. I had the whipple procedure done at mayo 2819 and got out of hospital on 219. Blood loss during operation influenced the prognosis. In the whipple operation, the head of the pancreas, a portion of the bile duct, the gallbladder and the duodenum are removed. To assess the adequacy of pyloruspreserving pancreatoduodenectomy pppd as a definitive surgical treatment for primary malignant diseases of the periampullary region.
About your whipple procedure memorial sloan kettering. The whipple procedure is an operation to remove a pancreatic tumour and a lot of the tissue around it. The whipple install was very easy and straightforward compared to installing the forged internals. Pyloruspreservation decreases the extent of atrophy of the remnant.
There is a sidetoside gastrojejunostomy, often with a long afferent loop and a variety of placements for the pancreatico and. Median duration of the whipple operation was 265 range 203475 min with a median blood loss of 570 508540 ml. Overall, the fiveyear survival rate after a whipple procedure is about 20 to 25%. It also removes the duodenum, the pylorus lower part of the stomach, the gallbladder and part of the common bile duct. The aggressive, difficult procedure is recommended when the pancreatic cancer is confined to the head of the pancreas. My wife couldnt face taking me and leaving me there. Standard whipple type operation or pylorus preserving pd pppd was performed. Apr 22, 20 the head resection surgeries analyzed in the study included 69. It is one of the most common types of surgery for pancreatic cancer. Just had follow up at mayo 41, and the surgical crew thought i. Whipple, american surgeon, 18811963 radical pancreaticoduodenectomy with removal of the distal third of the stomach, the entire duodenum, and the head of the pancreas, a portion of the jejunum, and the lower half of the common bile duct, with gastrojejunostomy, choledochojejunostomy, and. Hello, my husband had a whipple procedure 5 months ago, the surgeons had to remover all of his pancreas, his gallbladder and his spleen as well as part of the duedunum.
Delayed gastric emptying was observed more frequently after pppd than after the whipple procedure, with marginal statistical signi. The whipple procedure isnt an option for the 40% of newly diagnosed patients whose tumors have spread beyond the pancreas and only rarely is. A free powerpoint ppt presentation displayed as a flash slide show on id. Even if the procedure successfully removes the visible tumor, it. Seiler et al 19 found shorter operation time, less blood loss, and fewer blood transfusions in the pppd group of their series of 77 patients. A whipple procedure can be assumed if the features listed above are present. A singleinstitution randomized controlled trial was conducted to compare the results of standard whipple operation sw with those of pyloruspreserving pancreaticoduodenectomy pppd. A whipple procedure also known as a pancreaticoduodenectomy is a. Department of surgery, suratthani hospital, mueang district, suratthani 84000, thailand. Whipple whipple procedure, or kausch whipple procedure, is a major surgical operation involving the pancreas, duodenum, and other organs.
Whipple complication digestive diseases abdomen scribd. Pancreaticoduodenectomy 1 pancreaticoduodenectomy whipple. Kauschs patient survived for 9 months, whipple s for 8 months. Whipple surname including a list of people with the surname whip jones 19092001, american ski industry pioneer, founder, developer and original operator of the aspen highlands ski area in aspen, colorado. Jul 10, 20 whipple whipple procedure, or kausch whipple procedure, is a major surgical operation involving the pancreas, duodenum, and other organs. Some doctors think this helps with food digestion after the operation. Whipple procedure and follow up chemo mayo clinic connect. When the muscles or nerves of the stomach prevent proper grinding and emptying of the stomach, nausea, vomiting, and abdominal pain follow. Whipple van buren phillips 18331904, american businessman, grandfather of h. For tumors of the head and neck of the pancreas a whipple procedure.
Fourth floor san francisco, ca 94115 415 8857404 new patient appointments 415 3537687 main phone 415 3537781 fax. Pylorus preserving pancreaticoduodenectomy versus standard. The pigtail catheter by manish medi innovation empties liquids or lets some circulation into of pleural spaces inside. Whipple procedure survivors is a facebook group i cant live without. A support group for what we call whipple pains whipple pain attacks is a good support for the pain involved in post whipple life. Rationale dge is regarded as the most common complication postwhipples operation. Removal of the head of the pancreas, the gallbladder, portions of the duodenum, small portions of the stomach, and the lymph nodes near the head of the pancreas.
Pd and pppd procedures are equally effective operations regarding the postoperative. Evaluation of survival in patients after pancreatic head. Whipple surgery effectively reorganizes the bodys digestive system, and aside from cutting away parts of the pancreas, it removes the bile duct, and in some cases, portions of the digestive system like the small. Although first performed by the german surgeon kausch in 1909, the operation was popularized by dr. A 5 french pediatric feeding tube can be used as a pancreatic duct stent when closing a twolayered endtoside pancreaticojejunostomy. Horacio asbun, mayo clinic in florida, explains the whipple procedure using this animated graphic of a pancreas. This video is intended to help patients with the process of providing informed consent to have the whipple procedure. The whipple procedure may also be used to treat some benign pancreatic lesions and read more. Had to go back to my local hospital a week later for dehydration pain and nausea, and was there for a week. After a large cut is made in your belly, the surgeon will look at the pancreas and other organs in the area, including lymph nodes, to see if the cancer has spread. Pancreaticoduodenectomy is a complex, highrisk surgical procedure. Whipple procedure the national pancreas foundation.
Distal pancreatectomy this procedure is performed for tumours of the body and tail of the pancreas. Whipple performed his operation 25 years after kausch, on august 21, 1934. Background some background information regarding pyloruspreserving pancreaticoduodenectomy pppd, also commonly referred to as the whipple procedure, is provided below. Though the stomach typically relaxes and returns to its normal functioning ability within 68 weeks, until then, the patient. The whipple procedure, or pancreaticoduodenectomy, is the most common surgery to remove tumors in the pancreas. Between january 2000 and december 2004, 27 patients with pancreatic or periampullary adenocarcinoma. But delayed gastric emptying was more frequently encountered in pppd than in the whipple procedure. The classic pancreaticoduodenectomy described by whipple consists of removal of the pancreatic head, duodenum, first 15 cm of the jejunum, common bile duct, and gallbladder, as well as a partial gastrectomy fig. Whipple procedure survival ratepancreatic cancer surgery duration. The whipple procedure pancreaticoduodenectomy is an operation to remove the head of the pancreas, the first part of the small intestine duodenum, the gallbladder and the bile duct. Mar 03, 2009 this animation shows a pancreaticoduodenectomy, pancreatoduodenectomy, whipple procedure, or kausch whipple procedure. Pancreaticoduodenectomy pd is a complex surgery, commonly performed for malignant tumors of pancreatic head, ampulla, distal bile duct, and may be performed for benign tumors, and trauma of pancreatic head and duodenum, while rarely perform for chronic pancreatitis 1,2.
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