Pancreatectomy, proximal subtotal with total duodenectomy, partial gastrectomy, choledochoenterostomy and gastrojejunostomy (Whipple-type procedure); with pancreatojejunostomy
CPT4 code
Name of the Procedure:
Pancreatectomy, Proximal Subtotal with Total Duodenectomy, Partial Gastrectomy, Choledochoenterostomy and Gastrojejunostomy (Whipple-type Procedure); with Pancreatojejunostomy
Summary
The Whipple procedure, also known as a pancreaticoduodenectomy, is a complex surgical operation performed to remove parts of the pancreas, duodenum, gallbladder, bile duct, and stomach. It then reconstructs the digestive tract by connecting the remaining organs to restore digestive function.
Purpose
The procedure is primarily used to treat pancreatic cancer, but it can also be performed for other malignant and benign conditions affecting the pancreas and surrounding organs. The goals include removing cancerous or diseased tissue, alleviating symptoms, and attempting to cure the disease.
Indications
- Pancreatic cancer
- Tumors in the bile duct or duodenum
- Chronic pancreatitis not responsive to other treatments
- Cancer of the ampulla of Vater
- Some cases of trauma to the pancreatic area
Preparation
- Fasting from midnight before the surgery
- Pre-operative blood tests, imaging studies, and possibly an endoscopic ultrasound
- Cessation or adjustment of certain medications, particularly blood thinners
- Meeting with the anesthesiologist and surgical team for pre-operative assessment
Procedure Description
- Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
- Incision: A large abdominal incision is made to access the internal organs.
- Resection: Surgeons remove the head of the pancreas, the entire duodenum, a portion of the stomach, the gallbladder, and parts of the bile duct.
- Reconstruction:
- Choledochoenterostomy: The bile duct is connected to the small intestine.
- Gastrojejunostomy: The stomach is connected to the small intestine.
- Pancreatojejunostomy: The remaining pancreas is attached to the small intestine.
- Closure: The incision is closed with sutures or staples.
Duration
The procedure typically takes 5-8 hours, depending on the complexity and any complications that arise.
Setting
The surgery is performed in a hospital operating room equipped for major surgical procedures.
Personnel
- Surgical team including one or more specialized surgeons
- Anesthesiologist and anesthesia technicians
- Surgical nurses and assistants
- Post-operative care team
Risks and Complications
- Common risks: Infection, bleeding, delayed gastric emptying, leakages from connections made during surgery
- Rare but serious risks: Pancreatic fistula, sepsis, significant intra-abdominal hemorrhage
- Long-term complications: Nutritional deficiencies, diabetes, digestive difficulties
- Management includes antibiotics, blood transfusions, and additional surgeries if necessary.
Benefits
- Potential removal of cancerous tumors and extension of survival
- Relief from symptoms like jaundice, pain, and digestive issues
- Improved quality of life
Recovery
- Hospital stay: Typically 1-2 weeks
- Pain management: Includes intravenous pain medications transitioning to oral painkillers
- Diet: Gradual reintroduction starting with liquids, progressing to solids as tolerated
- Activity: Limited physical activity initially, with gradual increase as healing progresses
- Full recovery: Usually takes several months, with follow-up appointments and possible adjuvant therapy (e.g., chemotherapy)
Alternatives
- Radiation therapy or chemotherapy, which may be less effective in cases of localized pancreatic cancer
- Total pancreatectomy in extensive disease, which results in diabetes and lifelong pancreatic enzyme replacement
- Palliative care for symptom management in advanced, non-resectable cases
Patient Experience
- During: Patient is under general anesthesia and will not feel or be aware of the procedure.
- After: Post-surgical pain managed with medications, experience fatigue, and potential digestive changes. Supportive care, including nutritional guidance and physical rehabilitation, is essential for recovery.
- Pain and discomfort will be present initially, with gradual improvement; constant communication with the healthcare team is crucial to address any concerns promptly.