Pancreatectomy, proximal subtotal with total duodenectomy, partial gastrectomy, choledochoenterostomy and gastrojejunostomy (Whipple-type procedure); without pancreatojejunostomy
CPT4 code
Name of the Procedure:
Pancreatectomy, proximal subtotal with total duodenectomy, partial gastrectomy, choledochoenterostomy, and gastrojejunostomy (Whipple-type procedure); without pancreatojejunostomy. Often referred to as a modified Whipple procedure, it is also known as a pancreaticoduodenectomy.
Summary
In simple terms, this procedure involves the surgical removal of parts of the pancreas, duodenum, and stomach, and the rerouting of bile and digestive juices to the small intestine. This is a complex surgery typically performed to treat certain types of cancer or other severe diseases affecting these organs.
Purpose
This surgery is primarily used to treat pancreatic cancer, bile duct cancer, and other malignant or benign diseases affecting the pancreas, duodenum, or bile duct. The main goal is to remove the diseased tissue and reroute digestive pathways to ensure the digestive system continues to function.
Indications
- Pancreatic cancer in the head or neck of the pancreas
- Ampullary cancer
- Bile duct cancer
- Duodenal cancer
- Chronic pancreatitis with intractable pain
- Benign tumors causing obstruction
Preparation
- Fasting for at least 8 hours prior to surgery
- Blood tests, imaging studies (CT, MRI), and endoscopic assessments
- Discontinuation of certain medications such as blood thinners
- Consultation with anesthesiologist and surgical team
Procedure Description
- Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
- Incision: A large incision is made in the abdomen to access the pancreas and surrounding organs.
- Resection: The surgeon removes the head of the pancreas, the duodenum, part of the stomach, and sometimes part of the bile duct.
- Choledochoenterostomy: The common bile duct is sewn to the small intestine to allow bile to flow from the liver to the intestine.
- Gastrojejunostomy: The remaining part of the stomach is connected to the jejunum (a part of the small intestine) to enable normal digestion.
- Closure: The incision is closed with sutures or staples.
Duration
The procedure typically takes 5 to 8 hours, depending on the complexity of the case.
Setting
This surgery is performed in a hospital operating room equipped with advanced surgical technology.
Personnel
- Lead Surgeon (specialized in gastrointestinal or oncologic surgery)
- Assistant Surgeons
- Anesthesiologist
- Scrub Nurses
- Surgical Technicians
Risks and Complications
- Infection
- Bleeding
- Delayed gastric emptying
- Fistula formation
- Nutritional deficiencies
- Diabetes mellitus
- Death (though rare, it is a major surgery with inherent risks)
Benefits
The primary benefit is the potential cure or significant treatment of cancer or other serious conditions. Patients typically start to notice improvements a few weeks to months post-surgery.
Recovery
- Initial hospitalization for about 1 to 2 weeks
- Gradual reintroduction of oral intake
- Pain management using prescribed medications
- Avoid heavy lifting for several weeks
- Follow-up appointments for monitoring and evaluation
- Possible need for enzyme supplements or dietary adjustments
Alternatives
- Total pancreatectomy
- Palliative care (for non-surgical candidates)
- Endoscopic stent placement to relieve obstruction
- Chemotherapy and radiation therapy Each alternative has its own set of pros and cons, with this surgery often providing the best chance for long-term survival in cases of localized pancreatic cancer.
Patient Experience
During the procedure, the patient will be unconscious and pain-free due to general anesthesia. Postoperatively, pain management is achieved through medication. The patient may experience some discomfort, fatigue, and temporary dietary restrictions. Effective pain management protocols and support from the healthcare team aim to maximize comfort during recovery.