• The initial portion of the operative procedure is dedicated to the assessment of respectability
• The duodenum and the head of the pancreas is elevated out of the retroperitoneum
• Resection involve the division of the pancreatic neck and the final dissection of the head and uncinate process from the superior mesenteric vein, portal vein, and superior mesenteric artery

The most common reconstructive technique anastomoses the pancreas to the jejunum first, followed by the bile duct and the duodenum. An alternative for pancreatic-enteric reconstruction involves the use of a pancreaticogastrostomy.

There are several techniques of pancreaticoduodenectomy. Classic pancreaticoduodenectomy includes distal gastrectomy whereas pylorus-preserving pancreaticoduodenectomy preserves the entire gastric reservoir and the pyloric sphincter, maintains more normal gastric acid secretion and hormone release. Since pylorus preservation does not seem to be associated with any consistent additional complications, pylorus preservation is favored in most patients who undergo pancreaticoduodenectomy.

The main steps in Pylorus Preserving Whipple's Procedure include:

• Resection of Head of Pancreas

• Resection of Distal CBD

• Resection of proximal pancreatic duct

• Anastomoses between:

  1. CHD & Jejunum

  2. Pancreatic duct & Jejunum

  3. Pylorus & Jejunum

References:

Yeo CJ.  Management of complications following pancreaticoduodenectomy. Surg Clin North Am 75:913-924, 1995.

Townsend: Sabiston Textbook of Surgery, 16th ed., Copyright © 2001 W. B. Saunders Company