Pylorus-Preserving Pancreaticoduodenectomy for Pancreatic Cancer: How I Do It
Pylorus-preserving partial pancreaticoduodenectomy is considered to be one of the most demanding and comprehensive operative procedures in visceral surgery and is usually performed for malignant lesions of the pancreatic head, the distal bile duct, or the duodenum. Numerous modalities of this procedure, which can be structurally divided into exploration, resection, and reconstruction, have been defined. The particularly determining relevance of postoperative pancreatic fistulas probably causes the outstanding key role of the pancreatic (duct) anastomosis during the procedure, which led to multitudinous clinical and experimental studies aiming for the best anastomotic technique. This chapter describes the procedure of the pylorus-preserving pancreaticoduodenectomy as performed at our center, illustrates the distinct operative phases with detailed pictures, and puts special emphasis on both the pancreatic and the biliodigestive anastomoses with clear drawings.
Intraductal papillary mucinous neoplasm
Superior mesenteric artery
Superior mesenteric vein
- 1.Huttner FJ, Fitzmaurice C, Schwarzer G, Seiler CM, Antes G, Buchler MW, et al. Pylorus-preserving pancreaticoduodenectomy (pp Whipple) versus pancreaticoduodenectomy (classic Whipple) for surgical treatment of periampullary and pancreatic carcinoma. Cochrane Database Syst Rev. 2016;2:CD006053.PubMedPubMedCentralGoogle Scholar
- 16.Mihaljevic AL, Schirren R, Ozer M, Ottl S, Grun S, Michalski CW, et al. Multicenter double-blinded randomized controlled trial of standard abdominal wound edge protection with surgical dressings versus coverage with a sterile circular polyethylene drape for prevention of surgical site infections: a CHIR-Net trial (BaFO; NCT01181206). Ann Surg. 2014;260(5):730–7; discussion 7–9.CrossRefPubMedCentralPubMedGoogle Scholar