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Open Pancreaticoduodenectomy for Peri-Ampullary Cancers

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Pancreaticoduodenectomy is a technically challenging procedure composed of multiple individual steps, many of which have multiple variations. This chapter describes the procedure of open pancreaticoduodenectomy in a step-by-step fashion and discusses variations in technique and complex situations that may be encountered.


  • Pancreaticoduodenectomy
  • Pancreatic cancer
  • Ampullary cancer
  • Extrahepatic cholangiocarcinoma
  • Hepaticojejunostomy
  • Pancreaticojejunostomy
  • Pancreatic fistula
  • Delayed gastric emptying

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  • DOI: 10.1007/978-1-4939-1893-5_10
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Correspondence to Andrew M. Lowy M.D. .

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Key Operative Steps

Key Operative Steps

  1. 1.

    Explore to evaluate for occult metastatic disease.

  2. 2.

    Enter the lesser sac and expose the inferior border of the pancreas.

  3. 3.

    Mobilize the hepatic flexure to expose Gerota’s fascia and the duodenum.

  4. 4.

    Perform a wide Kocher maneuver to the left renal vein and ligament of Treitz.

  5. 5.

    Dissect the porta hepatis: open the gastrohepatic ligament, divide the right gastric artery, resect the common hepatic artery lymph node, divide the gastroduodenal artery, perform cholecystectomy, and divide the common bile duct.

  6. 6.

    Transect the antrum of the stomach or proximal duodenum.

  7. 7.

    Divide the proximal jejunum and the mesentery to it up to the ligament of Treitz.

  8. 8.

    Transect the neck of pancreas.

  9. 9.

    Pass the distal duodenum and proximal jejunum underneath the superior mesenteric vessels to the right side of the abdomen and dissect the head and uncinate process of the pancreas from the superior mesenteric vein-portal vein and from the right lateral aspect of the superior mesenteric artery.

  10. 10.

    Perform reconstruction: pancreaticojejunostomy, hepaticojejunostomy, and gastrojejunostomy/duodenojejunostomy.

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Kelly, K.J., Lowy, A.M. (2015). Open Pancreaticoduodenectomy for Peri-Ampullary Cancers. In: Kim, J., Garcia-Aguilar, J. (eds) Surgery for Cancers of the Gastrointestinal Tract. Springer, New York, NY.

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  • Print ISBN: 978-1-4939-1892-8

  • Online ISBN: 978-1-4939-1893-5

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