HPB

Pancreaticoduodenectomy (Whipple Procedure)

PANCREATICODUODENECTOMY (WHIPPLE PROCEDURE)

Indication: Carcinoma of the head of the pancreas, periampullary tumour (ampullary, duodenal, or distal bile duct carcinoma), or other resectable lesions of the pancreatic head/uncinate process. Pre-operative resectability assessed on CT angiography — no arterial involvement, SMV/portal vein reconstructable.

Patient Position: Supine.

Anaesthesia: General (with or without epidural).

Prophylactic Antibiotics: Per protocol.

Incision: Midline laparotomy or bilateral subcostal (Mercedes). Laparoscopic/robotic approaches in specialist centres.

Resection Phase:
1. Abdomen entered. Full staging: liver, peritoneum, and regional nodes inspected. No evidence of metastatic disease confirmed.
2. Kocher manoeuvre: duodenum and pancreatic head mobilised by incising the lateral peritoneal reflection. Inferior vena cava and aorta palpated posteriorly. Superior mesenteric vein (SMV) and portal vein (PV) exposed along the inferior border of the pancreas.
3. Cholecystectomy performed. Common hepatic duct divided at the level of the bile duct–cystic duct junction.
4. Gastric antrum divided (classic Whipple) or duodenum divided 2 cm distal to the pylorus (pylorus-preserving Whipple/PPPD).