Distal pancreatectomy vs Whipples procedure

02 Mar, 2021

Whipples’ procedure (part 1: removal )

If a tumor involves the head of the pancreas, we perform a procedure called Whipples’ or pancreatoduodenectomy. It involves removal of head of pancreas, part of bile duct, gallbladder, part of intestine called duodenum. Sometimes a part of stomach called pylorus has to be removed alongwith. Also it may involve removal of an important structure nearby called the portal vein depending upon preop assessment on CT. I performed my first pylorus preserving Whipples surgery 10 years back. This helps in earlier improvement in postoperative quality of life.

Whipples’ procedure (part 2: reconstruction)

This step involves reconstruction of pancreas, bile duct, intestine and portal vein. This is an equally critical step involving making of 3-4 new internal connections: pancreas to intestine (most critical), bile duct to intestine, stomach to intestine and intestine to intestine. 2 drainage tubes and a nasogastric tube have to be inserted in the end. I have done detailed clinical research on safe ways of joining the pancreas to intestine during training phase. It showed that

 

 

Distal pancreatectomy

If a tumor lies in body or tail of pancreas, we perform a procedure called distal pancreatectomy. In most cases, the blood vessels of spleen are seen to lie in direct contact with the pancreas and the tumor itself. So, a splenectomy has to be done along with. In such a case, vaccines have to be given to the patient to protect against three potential bacterial infections (pneumococcus, meningococcus, hemophilus influenza) and repeated every 3 years thereafter. Distal pancreatectomy is amenable to laparoscopic surgery. I performed my first laparoscopic distal pancreatectomy (for a neuroendocrine tumor of pancreas) about 8 years ago and have successfully treated numerous such patients with faster recovery and smaller incision.