Patients all consecutive patients undergoing total laparoscopic pancreaticoduodenectomy from july 2007 through july 2009 at a single center n 62. Postrygb anatomy poses considerable challenges for reconstruction after pancreaticoduodenectomy pd, a growing problem encountered by surgeons. After its oncological adequacy was questioned initially, pyloruspreserving pd was shown to be equivalent to the classic whipple procedure regarding tumor recurrence and longterm survival. Illustration of the sixstep pancreaticoduodenectomy whipple operation as described in a number of recent text books by dr. Successful eusguided nondilated pancreatic duct stent. Pylorus preserving pancreaticoduodenectomy is a variation of the classic whipple operation. Several surgeons in the united states and abroad subsequently developed twostage operations for removal of the head of. The pyloruspreserving pancreaticoduodenectomy, whereby the stomach and pylorus are left in situ, was first described by dr. Pppd has been associated with a higher incidence of delayed gastric emptying, resulting in a prolonged period of postoperative nasogastric suctioning. Herein, we describe the advanced endoscopic rescue of a duodenojejunostomy dj leak after pylorus preserving pancreaticoduodenectomy pppd in a postesophagectomy patient.
The pathogenesis of dge after pppd has been speculated to be related to factors such as. A 64yearold woman with a surgical history of pylorus preserving pancreaticoduodenectomy for pancreatic adenocarcinoma presented for endoscopic management of postoperative anastomotic bile leak and suspected stricture at hepaticojejunostomy, which persisted despite surgical and percutaneous intervention. Pylorus preserving pd has gained wide acceptance as standard procedure and is being performed by an increasing number of pancreatic surgeons. A modification of the conventional procedure, pyloruspreserving pancreaticoduodenectomy preserves the gastric antrum, pylorus, and the proximal 2 to 3 cm. However, it is technical challenging to perform laparoscopic. Jul 23, 2015 pylorus preserving pancreaticoduodenectomy traversolongmire procedure. The pyloruspreserving whipple pancreaticoduodenectomy is becoming a popular alternative to the standard whipple operation.
Majella doyle pancreaticoduodenectomy pd has become the standard of care for resectable pancreatic cancer and premalignant lesions in the periampullary region. Laparoscopic pancreaticoduodenectomy lpd is difficult to perform for this condition because of smaller size of pancreatic and hepatic ducts more so in paediatric population. Instead, we attempted antegrade stent placement by the use of euspd video 1 x download 108 mb video 1 demonstration of eusguided nondilated pancreatic duct stenting in patient with pancreatic fistula after pancreaticoduodenectomy. Pancreaticoduodenectomy for pancreatic head cancer. Due to the shared blood supply of organs in the proximal gastrointestinal system, surgical removal of the head of the pancreas also. Preservation of the pylorus in pancreaticoduodenectomy has been shown in retrospective studies to lead to a longterm improve.
With increasing numbers of longterm survivors after pyloruspreserving pancreatoduodenectomy pppd, postoperative quality of life qol has become a great concern. A 64yearold woman with a surgical history of pyloruspreserving pancreaticoduodenectomy for pancreatic adenocarcinoma presented for endoscopic management of postoperative anastomotic bile leak and suspected stricture at hepaticojejunostomy, which persisted despite surgical and percutaneous intervention. Procedure performed by john chabot, md, columbia university medical center, new york, ny. Laparoscopic pancreaticoduodenectomy with major venous. The head of the pancreas is usually removed for malignancy involving the ampulla of vater, the lower end of the common duct, the head of the pancreas, or the duodenum. Improvement of delayed gastric emptying in pylorus. May 28, 2015 nanashima a, abo t, sumida y, tobinaga s, nonaka t, takeshita h, hidaka s, sawai t, yasutake t, nagayasu t. Laparoscopic pancreaticoduodenectomy is rarely performed, and it has not been particularly successful due to its technical complexity. Whipple pancreaticoduodenectomy 1 whipple pancreaticoduodenectomy. A prospective randomized multicenter study was performed to assess whether the results of pyloruspreserving pancreaticoduodenectomy pppd equal those of the standard whipple sw operation, especially with respect to duration of surgery, blood loss, hospital stay, delayed gastric emptying dge, and survival. Endoscopic management of a recalcitrant anastomotic bile leak. N2 surgical procedures to resect periampullary malignancies and benign processes have evolved over the last 100 years since halsted from the johns hopkins hospital reported the first successful resection of a periampullary cancer in.
It is characterized by maintaining the pylorus and the entire stomach with the intention of favouring. A pancreaticoduodenectomy, also known as a whipple procedure, is a major surgical operation most often performed to remove cancerous tumours off the head of the pancreas. Pylorus preserving pancreaticoduodenectomy article pdf available in clinical liver disease 53 march 2015 with 276 reads how we measure reads. Berge henegouwen mi, van gulik tm, dewit lt, et al. Request pdf pyloruspreserving pancreatoduodenectomy pancreaticoduodenectomy pd is the treatment of choice for various benign and malignant tumors of. Technical aspects of pancreaticoduodenectomy and their outcomes. This was initially performed under the hypothesis that preserving the pylorus could reduce postoperative reflux, dumping, diarrhea, and its. Pyloruspreserving pancreaticoduodenectomy johns hopkins. According to many authors dealing with this issue, this procedure improves the quality of life of these patients. Pyloruspreserving pancreaticoduodenectomy with complete preservation of the pyloroduodenal blood supply and innervation. Pyloruspreserving pancreaticoduodenectomy with complete.
The pylorus preserving whipple pancreaticoduodenectomy is becoming a popular alternative to the standard whipple operation. Pylorus preserving pancreaticoduodenectomy youtube. In recent years the pylorus preserving pancreaticoduodenectomy also known as traversolongmire procedurepppd has been gaining popularity, especially among european surgeons. Reconstruction options following pancreaticoduodenectomy. Today, preservation of the pylorus has been widely accepted as the surgical standard in this procedure. To evaluate the safety, feasibility, and oncologic outcomes of laparoscopic pyloruspreserving pancreaticoduodenectomy lpppd to treat periampullary tumors. Jan 28, 2019 conventional pancreaticoduodenectomy involves a distal gastrectomy with removal of the pancreatic head, duodenum, first 15 cm of the jejunum, common bile duct, and gallbladder figure 1. Longterm evaluation of pylorus preservation during.
Delayed gastric emptying after pancreaticoduodenectomy. Laparoscopic pylorus preserving pancreaticoduodenectomy for periampullary carcinoma duration. Pyloruspreserving pancreaticoduodenectomy with partial excision of superior mesenteric vein and primary repair. During 1990 to 1997 a series of 39 patients underwent a classic pancreaticoduodenectomy and 74 a pylorus preserving pancreaticoduodenectomy for pancreatic adenocarcinoma.
It is also used for the treatment of pancreatic or duodenal trauma, or chronic pancreatitis. Pylorus preserving pancreaticoduodenectomy versus standard w. To determine if an antecolic or a retrocolic duodenojejunostomy during pyloruspreserving pancreaticoduodenectomy pppd was associated with the least incidence of delayed gastric emptying dge, in a prospective, randomized, controlled trial. Pyloruspreserving versus standard pancreaticoduodenectomy 6369 general hospital beijing, china between january 2003 and february 2010 were eligible for participation in the present. Endoscopic management of a recalcitrant anastomotic bile. Minimally invasive pancreaticoduodenectomy, first described by gagner and pomp in 1994, 1 has made a significant progression in the past few years due to the evolution in surgical techniques and advancement in instrumentation. Quality of life after pyloruspreserving pancreatoduodenectomy. Classic whipple versus pylorus preserving pancreaticoduodenectomy.
Fluoroscopy plays an important role in postoperative assessment. Another criticism of the pylorus preserving pancreaticoduodenectomy for patients with a malignancy is the radicalness of the resection. Learn about the open pylorus preserving pancreaticoduodenectomy pppd, an online 3d video based course, accredited by the royal college of surgeons of england. Another criticism of the pyloruspreserving pancreaticoduodenectomy for patients with a malignancy is the radicalness of the resection. Although the technique is widely adopted, pylorus preservation in the setting of cancer, remains controversial. Autoplay when autoplay is enabled, a suggested video will. Aug 07, 2012 surgery theater, with more than 12,000 educational surgery videos, is the worlds first online social medical video sharing for all health care professionals. Pyloruspreserving pancreaticoduodenectomy whipple procedure. Laparoscopic pylorus preserving pancreaticoduodenectomy. Early enteral feeding after pylorus preserving pancreatoduodenectomy the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. In this study, the functional status of patients recovered from pyloricpreserving pancreaticoduodenectomy was evaluated by comparing 6 longterm survivors of the standard whipple procedure 17 years postoperative.
Resectable carcinoma of the head of the pancreas can be treated with either standard the whipple or pyloruspreserving pancreaticoduodenectomy pppd. Pyloruspreserving pancreaticoduodenectomy pp whipple versus pancreaticoduodenectomy classic whipple for surgical treatment of periampullary and pancreatic carcinoma. This course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a test. Open pancreaticoduodenectomy opd with major vascular resection and reconstruction has been shown in many studies to have shortterm and longterm outcomes that are similar to those of patients undergoing a pure pancreaticoduodenectomy without venous resection 1,2. Pyloruspreserving pancreaticoduodenectomy pp whipple. A modification of the conventional procedure, pylorus preserving pancreaticoduodenectomy preserves the gastric antrum, pylorus, and the proximal 2 to 3 cm. Pylorus preserving pancreaticoduodenectomy article pdf available in clinical liver disease 53. The main stages of this operation is presented in this video. Postesophagectomy anatomy, particularly the vascular supply, makes this a complex operation. Laparoscopic pylorus preserving pancreaticoduodenectomy in. Pylorus preserving pancreaticoduodenectomy versus standard.
The objective of this study is to highlight how robotic surgery could improve a minimally invasive approach and to expose the usefulness of robotic surgery even in complex surgical procedures. Comparison of results between pyloruspreserving pancreaticoduodenectomy and subtotal stomachpreserving pancreaticoduodenectomy. A common postoperative complication is the occurrence of delayed gastric emptying dge, which causes impairment of oral intake andpatients quality of life, prolongation of hospital stay and. With increasing numbers of longterm survivors after pylorus preserving pancreatoduodenectomy pppd, postoperative quality of life qol has become a great concern. She underwent laparoscopic pylorus preserving pancreaticoduodenectomy. Nearly 60,000 people are diagnosed with pancreatic cancer in the united states each year. Pylorus preserving pancreaticoduodenectomy garonzik. Pyloric preservation pp can frequently be performed at the time of pancreatoduodenectomy pd, although some reports have linked it to inferior outcomes such as delayed gastric emptying dge. Technical aspects of pancreaticoduodenectomy and their. Autoplay when autoplay is enabled, a suggested video will automatically play next. What is the whipple pancreaticoduodenectomy procedure. Only a few reports compared the differences between these two procedures.
Pancreaticoduodenectomy pd has become the standard of care for resectable pancreatic cancer and premalignant lesions in the periampullary region. As viewers watch a pyloruspreserving pancreaticoduodenectomy on a 62yearold woman with a pancreatic head neoplasm, dr. Pancreatoduodenectomy with or without pyloric preservation. Resection of the pancreatic head could be performed without the usual crosssection at the isthmus, the pancreatic remnant was drained by pancreaticogastrostomy. Pylorus preserving pancreaticoduodenectomy traversolongmire. The authors evaluated images of 50 consecutive patients who had undergone the newer procedure.
Partial pancreaticoduodenectomy pd is the standard treatment for tumors of the pancreatic head. After its oncological adequacy was questioned initially, pylorus preserving pd was shown to be equivalent to the classic whipple procedure regarding tumor recurrence and longterm survival. Resectable carcinoma of the head of the pancreas can be treated with either standard the whipple or pylorus preserving pancreaticoduodenectomy pppd. Society of american gastrointestinal and endoscopic surgeons sages 11,301 views. Delayed gastric emptying after standard pancreaticoduodenectomy versus pyloruspreserving pancreaticoduodenectomy. However, few reports are available on data of the postoperative changes in qol after pppd. Background pancreatic cancer is the fourth leading cause of cancer death for men and the fifth for women. Pyloruspreserving pancreaticoduodenectomy request pdf. Matthew walsh, md, demonstrates the complex laparoscopicrobotic procedure in this instructional video. Pylorus preservation pancreatectomy or not klaiber. So if you are looking to learn the latest surgical procedures or share your latest surgical knowledge, feel free to browse, learn, share and discuss all for free. In 1898, halsted was the first to successfully remove the head of the pancreas and a portion of the duodenum for ampullary cancer. Pancreaticoduodenectomy surgery video general surgery video.
The standard treatment for resectable tumours consists of a classic whipple cw operation or a pylorus preserving pancreaticoduodenectomy ppw. Pylorus preserving pancreaticoduodenectomy traverso. Pancreaticoduodenectomy has evolved since kausch performed the first successful procedure as a twostage operation in 1912. Conventional pancreaticoduodenectomy involves a distal gastrectomy with removal of the pancreatic head, duodenum, first 15 cm of the jejunum, common bile duct, and gallbladder figure 1. Pyloruspreserving pd has gained wide acceptance as standard procedure and is being performed by an increasing number of pancreatic surgeons. Request pdf pylorus preserving pancreatoduodenectomy pancreaticoduodenectomy pd is the treatment of choice for various benign and malignant tumors of the pancreatic head or the periampullary.
The two groups had similar tumor characteristics and received comparable adjuvant treatments. The pylorus preserving pancreaticoduodenectomy, whereby the stomach and pylorus are left in situ, was first described by dr. A common postoperative complication is the occurrence of delayed gastric emptying dge, which causes impairment of oral intake andpatients quality of life. Pyloruspreserving pancreaticoduodenectomy is an accepted treatment for benign and malignant diseases of the pancreas. Patients with earlystage disease can be the candidates for the functional operation pancreatoduodenectomy with preservation of the pylorus. The need for a whipple procedure after esophagectomy is rarely reported. Multiple publications have touted its feasibility and our group has shown its safety in comparison to open pancreaticoduodenectomy. Aug, 2018 obesity is a risk factor for pancreatic cancer which may be treated with rouxeny gastric bypass and represents an increasing morbidity. On the other hand, pppd might be associated with a. We characterize specific strategies used for postpd reconstruction in the rygb patient. Pyloruspreserving pancreatoduodenectomy request pdf. The operation is divided into six clearly defined steps to allow safe removal of the pancreatic head, distal stomach, duodenum, bile duct and gallbladder. Open pylorus preserving pancreaticoduodenectomy pppd. Oct 16, 2014 pyloruspreserving pancreaticoduodenectomy.
The video presents a robotic pyloruspreserving pancreaticoduodenectomy for periampullary carcinoma in a female patient. Biliary enteric continuity is reestablished by a cholodochojejunostomy and pancreatic enteric continuity is reestablished either by a pancreaticogastrotomy or. Main outcome measures blood loss, operative time, postoperative morbidity, length of hospital stay, and 30day or inhospital mortality. Pyloruspreserving pancreaticoduodenectomy operative. Pylorus preserving pancreaticoduodenectomy listed as pppd. Pyloruspreserving pancreaticoduodenectomy uptodate. Missing pancreatic isthmus during pancreaticoduodenectomy.
Robotic pancreaticoduodenectomy in a case of duodenal. Pyloruspreserving pancreatoduodenectomy germany duration. Medical transcription reference transcribed mt example reports. Pyloruspreserving pancreaticoduodenectomy definition of. The main advantage of this technique is that the pylorus, and thus normal gastric emptying, should in theory be preserved. Pylorus preserving pancreaticoduodenectomy how is pylorus. In a 78yearoldwoman the unique observation of a missing pancreatic isthmus was made during pyloruspreserving pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. Nov 09, 2018 pyloruspreserving pancreaticoduodenectomy whipple procedure. The classic technique of pd consists of the enbloc removal of the distal segment of the stomach antrum, the first and the second portions of the duodenum, s. Background some background information regarding pyloruspreserving pancreaticoduodenectomy pppd, also commonly referred to as the whipple procedure, is provided below. Pylorus preserving pancreaticoduodenectomy jacqueline m. Walsh leads discussion of critical anatomy and technical concepts.
We report a case of 12 years old girl having spn arising from head of the pancreas. A 69yearold man, who had undergone pyloruspreserving pancreaticoduodenectomy pd imanaga procedure for duodenum papilla cancer years prior, had a history of repeated hospitalization due to cholangitis since the third year after surgery and liver abscess at the 10th year after surgery. Listing a study does not mean it has been evaluated by the u. Some element of delayed gastric emptying affects as many as 46% of patients. N2 surgical procedures to resect periampullary malignancies and benign processes have evolved over the last 100 years since halsted from the johns hopkins hospital reported the first successful resection of a periampullary cancer in 1899 1.
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