Pancreas

The Whipple procedure is, at minimum, a pancreaticoduodenectomy, which may or may not also include pylorus of the stomach and the gallbladder. In the pylorus-preserving Whipple procedure, the simplest version, you receive the segment of duodenum from just past the pylorus to about 20 cm beyond the ampulla of Vater. The head of the pancreas is nestled in the curve of the duodenum near the ampulla; the pancreas is shaped like a J, and the head is the base of the J, with the uncinate process as the hook. The distal common bile duct runs through the pancreas and enters the ampulla, where it is joined by the main pancreatic duct (Figure 10.1). Usually it is only the head of pancreas that comes out; if the tail is also involved, you may get the total pancreas and spleen.