Pancreatectomy, proximal subtotal with near-total duodenectomy, choledochoenterostomy and duodenojejunostomy (pylorus-sparing, Whipple-type procedure); without pancreatojejunostomy
CPT4 code
Name of the Procedure:
Pancreatectomy, proximal subtotal with near-total duodenectomy, choledochoenterostomy and duodenojejunostomy (pylorus-sparing, Whipple-type procedure); without pancreatojejunostomy
Summary
This surgical procedure involves the removal of part of the pancreas and most of the duodenum, along with reconnections of the bile duct and intestine, while preserving the stomach's pylorus (the opening to the small intestine). It's a complex surgery typically performed to treat certain cancers or severe chronic pancreatitis.
Purpose
The procedure is performed primarily to address pancreatic cancer, cancers of the bile duct or duodenum, and severe conditions like chronic pancreatitis. The goal is to remove the afflicted tissues while maintaining as much normal digestive function as possible.
Indications
- Diagnosed pancreatic or periampullary cancer
- Bile duct cancer
- Severe chronic pancreatitis
- Duodenal tumors
- Unmanageable symptoms from the aforementioned conditions
Preparation
- Fasting for at least 8 hours prior to the surgery
- Adjusting or stopping certain medications as advised by the doctor
- Comprehensive pre-surgical assessments including blood tests, imaging studies (CT scans, MRIs), and sometimes endoscopic procedures
Procedure Description
- The patient is under general anesthesia.
- An incision is made in the abdomen to access the pancreas and adjacent organs.
- The head of the pancreas, nearly all of the duodenum, and sometimes a portion of the bile duct are removed.
- The bile duct is connected to the intestine (choledochoenterostomy) and the remaining part of the duodenum is connected to the jejunum (duodenojejunostomy), sparing the pylorus.
- Surgical instruments used include scalpels, sutures, and possibly laparoscopic tools.
- Drains may be placed to remove fluid post-surgery.
Duration
The procedure typically takes 4 to 6 hours.
Setting
This surgery is performed in a hospital's surgical suite, often in facilities that specialize in complex abdominal surgeries.
Personnel
- Lead Surgeon (usually a specialist in hepatopancreatobiliary surgery)
- Surgical Assistants
- Anesthesiologist
- Operating Room Nurses
- Surgical Technicians
Risks and Complications
- Infection
- Bleeding
- Delayed gastric emptying
- Leakage from the reconnections
- Pancreatitis
- Nutritional deficiencies
- Long-term digestive issues
Benefits
- Effective removal of cancerous tissues
- Relief from severe symptoms of chronic pancreatitis or duodenal obstruction
- Potential for improved quality of life and prolonged survival in cancer patients
Recovery
- Initial hospitalization for 7 to 10 days.
- Pain management with medications.
- Gradual reintroduction of diet from liquids to solids.
- Avoiding heavy lifting and strenuous activities for at least 6 weeks.
- Follow-up appointments for monitoring recovery and managing any complications.
Alternatives
- Total pancreatectomy
- Chemotherapy and/or radiation therapy
- Endoscopic stenting for bile duct obstructions
- Less extensive surgical options if the disease is caught early
Pros of alternatives:
- Non-surgical options like chemotherapy/radiation can be less immediately invasive.
- Stenting may provide temporary relief without extensive surgery.
Cons of alternatives:
- They might not provide a definitive cure.
- The potential for recurrence of symptoms or disease progression.
Patient Experience
- Patients may experience significant pain immediately after surgery, which is managed with medications.
- There will be a period of weakness and fatigue during initial recovery.
- Gradual improvement in symptoms should occur within a few weeks, with full recovery taking several months.
- Emotional support and physical rehabilitation may be essential components of the recovery phase.