Pancreatectomy, proximal subtotal with near-total duodenectomy, choledochoenterostomy and duodenojejunostomy (pylorus-sparing, Whipple-type procedure); with pancreatojejunostomy
CPT4 code
Name of the Procedure:
Pancreatectomy, proximal subtotal with near-total duodenectomy, choledochoenterostomy and duodenojejunostomy (pylorus-sparing, Whipple-type procedure); with pancreatojejunostomy
Summary
This complex surgical procedure involves removing a portion of the pancreas, most of the duodenum, part of the bile duct, and reconnecting remaining parts of the digestive system. It aims to remove cancerous or diseased tissue while preserving the stomach's pylorus.
Purpose
This procedure is primarily used to treat pancreatic cancer, tumors of the duodenum, or other conditions indicating the removal of affected pancreatic and digestive tissues. The goal is to eliminate diseased tissue and restore as much normal digestive function as possible.
Indications
- Pancreatic cancer or pre-cancerous conditions
- Tumors in the duodenum
- Chronic pancreatitis
- Bile duct tumors or strictures
Preparation
- Fasting for 8-12 hours before surgery
- Consultation and assessments including blood tests, imaging (CT or MRI), and possibly endoscopic exams
- Adjusting medications, including blood thinners and diabetes treatments
Procedure Description
- Anesthesia: The patient is put under general anesthesia.
- Incision: A large incision is made in the abdomen to access the pancreas and nearby organs.
- Removal: The surgeon removes the head of the pancreas, most of the duodenum, part of the bile duct, and, if necessary, nearby lymph nodes.
- Reconnection: The bile duct is connected to the small intestine (choledochoenterostomy); the remaining part of the pancreas is connected to the small intestine (pancreatojejunostomy); and the stomach is connected to the jejunum, bypassing the removed duodenum (duodenojejunostomy), while sparing the pylorus.
- Closure: The incision is then closed with sutures or staples.
Duration
The procedure typically takes 5-8 hours.
Setting
Performed in a hospital with an advanced surgical suite.
Personnel
- Surgeon specialized in gastrointestinal or oncological surgery
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Common: Infection, bleeding, delayed gastric emptying
- Rare: Pancreatic fistula, severe pancreatic insufficiency, anastomotic leak
- Long-term: Nutritional deficiencies, diabetes
Benefits
- Potentially life-saving for patients with localized pancreatic or duodenal cancers
- May enhance quality of life by reducing symptoms caused by tumors
- Restores partial digestive function
Recovery
- Hospital stay of 7-14 days for monitoring and initial recovery
- Gradual return to normal activities over 6-8 weeks
- Dietary adjustments and possible enzyme supplements
- Follow-up visits to monitor healing and adjust treatments
Alternatives
- Total pancreatectomy
- Endoscopic stenting or drainage
- Palliative care and chemotherapy/radiation therapy
- Alternatives carry different levels of risk and benefits depending on the patient’s condition.
Patient Experience
Patients may experience discomfort and pain post-surgery, managed with medications. A period of adjustment is required due to changes in digestive function. Ongoing support from dietitians and healthcare professionals is integral to recovery.