PROXIMAL PANCREATODUODENECTOMY

Proximal pancreatoduodenectomy is a formidable operation that is performed mostly to treat malignant tumours arising from the head and uncinate process of the pancreas, the duodenum, the ampulla of Vater or the distal common bile duct. In some cases it may also be indicated for treating chronic pancreatitis and conditions that carry significant risk of progressing to cancer.

The procedure is often referred to as a “Whipple”after Dr Alan Whipple, one of the pioneering surgeons that first described the operation.

This is a highly complex operation and associated with potential serious early complications, as well as the risk of developing diabetes and chronic pancreatic exocrine insufficiency (shortage of pancreatic digestive enzymes), so it should only be done by surgeons with advanced training and lengthy experience in pancreatobiliary surgery, working in close collaboration with specialist intensive care physicians, endocrinologists and dieticians well-versed in the pathophysiological effects of the operation.

It involves removal of the head and uncinate process of the pancreas, the duodenum, the gallbladder and common bile duct, with reconstruction by anastomosing the pancreatic remnant to the proximal jejunum or stomach, common hepatic duct to proximal jejunum and stomach or proximal duodenum to the jejunum.

The classical operation originally described by Whipple, includes the removal of the distal stomach (gastric antrum and pylorus) as well. These days, we usually preserve the stomach and pylorus, with the operation correctly being called the pylorus-preserving proximal pancreatoduodenectomy (PPPPD).

Why do we perform the procedure?

The primary aim of the Whipple procedure for cancer is complete eradication of malignant tissue, prevention of recurrence, and reduction of metastatic risk. For many patients, this procedure represents the only opportunity for prolonged survival.

Are there any risks?

Like any surgery, with this procedure being highly complex, there may be risks, although it’s rare, such as:

• Excessive bleeding
• Infection
• The slow emptying of the stomach

Dr Stapleton conducts thorough pre-procedure consultations with all patients to explain expectations and the preparation required. His expertise in this procedure ensures patients receive comprehensive care