Pancreaticoduodenectomy - Revision history

Dominicmangino at 18:48, 14 September 2025

2025-09-14T18:48:21Z

← Older revision		Revision as of 11:48, 14 September 2025
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	\|-		\|-
	\|Postoperative disposition		\|Postoperative disposition
	\|		\|ICU
	\|		\|ICU
	\|-		\|-
	\|Pain management		\|Pain management

Dominicmangino: added intraoperative labs considerations

2025-09-14T18:40:43Z

added intraoperative labs considerations

← Older revision		Revision as of 11:40, 14 September 2025
Line 51:		Line 51:
	\|-		\|-
	\|Gastrointestinal		\|Gastrointestinal
	\|Check if patient has had a bowel prep, they may be dry		\|Check if patient has had a bowel prep, they may be dry, assess for obstruction or signs of full stomach
	\|-		\|-
	\|Hematologic		\|Hematologic
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	* EKG in any patient with risk factors for CAD		* EKG in any patient with risk factors for CAD
	*Type and Screen, have 2 units of pRBC on hold		*Type and Screen, have 2 units of pRBC on hold
			*consider intraoperative labs every 1-2 hours for acid/base, sugars, Hgb (if bleeding concerns),

	=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===		=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===

Tony.Wang at 02:47, 16 September 2022

2022-09-16T02:47:56Z

← Older revision		Revision as of 19:47, 15 September 2022
Line 81:		Line 81:

	* Many are ERAS pathway		* Many are ERAS pathway
			*Strongly consider acetaminophen, gabapentin, celecoxib, particularly if epidural is not used

	=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===		=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===
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	* Regular glucose checks and insulin infusion titration should occur throughout the procedure		* Regular glucose checks and insulin infusion titration should occur throughout the procedure
			*Consider epidural maintainance for intraop pain if BP tolerates (e.g. bupivacaine 0.125% 5-10 mL/hr)
			*Consider ketamine bolus (0.5 mg/kg) and infusion (0.2-0.3 mg/kg/hr), especially if epidural is not used

	=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===		=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===

Chris.Rishel at 07:10, 5 April 2022

2022-04-05T07:10:33Z

← Older revision		Revision as of 00:10, 5 April 2022
Line 2:		Line 2:
	\| anesthesia_type = General		\| anesthesia_type = General
	\| airway = ETT		\| airway = ETT
	\| lines_access = ~~PIV x 2 <br/> ART~~		\| lines_access = Large bore IV
	\| monitors = Standard ~~<br/>~~ 5-lead ~~EKG <br/>~~ ABP ~~<br/> +/-~~ CVP		Arterial line
	\| considerations_preoperative = Mechanical bowel prep ~~<br/>~~ ERAS		± Central line
	\| considerations_intraoperative = Combined general + epidural~~<br/>~~ Goal-directed fluid therapy ~~<br/>~~ Glucose control ~~<br/>~~ Blood transfusion management ~~<br/>~~ Lung protective ventilation ~~<br/>~~ Avoid hypothermia		\| monitors = Standard
	\| considerations_postoperative = PONV ~~<br/>~~ ERAS ~~<br/>~~ Goal-directed fluid therapy ~~<br/>~~ Early NG, foley, and drain removal ~~<br/>~~ Early PO nutrition ~~<br/>~~ Glycemic control~~<br/>~~ Non-opioid analgesia ~~<br/>~~ DVT ~~PPx <br/>~~ Pulmonary ~~rehab <br/>~~ Early ambulation		5-lead ECG
			ABP
			± CVP
			\| considerations_preoperative = Mechanical bowel prep
			ERAS
			\| considerations_intraoperative = Combined general ± epidural
			Goal-directed fluid therapy
			Glucose control
			Blood transfusion management
			Lung protective ventilation
			Avoid hypothermia
			\| considerations_postoperative = PONV
			ERAS
			Goal-directed fluid therapy
			Early NG, foley, and drain removal
			Early PO nutrition
			Glycemic control
			Non-opioid analgesia
			DVT prophylaxis
			Pulmonary rehabiliation
			Early ambulation
	}}		}}

	~~The Pancreaticoduodenectomy is~~ also known as ~~the~~ Whipple Procedure, after Dr. Allen Whipple~~. This~~ is the most commonly performed surgery to remove pancreatic tumors, and is typically done for patients who have tumors located in the head of the pancreas or adjacent regions. The procedure is anatomically complicated, and there may be anatomical variations among the various involved blood vessels and ducts in the area. Even after pancreatic resection, the 5-year survival rate is only 15-20% (compared with 5% without surgery).		A '''pancreaticoduodenectomy''' (also known as a '''Whipple Procedure''' after Dr. Allen Whipple) is the most commonly performed surgery to remove pancreatic tumors, and is typically done for patients who have tumors located in the head of the pancreas or adjacent regions. The procedure is anatomically complicated, and there may be anatomical variations among the various involved blood vessels and ducts in the area. Even after pancreatic resection, the 5-year survival rate is only 15-20% (compared with 5% without surgery).

	A standard whipple consists of resection of head of pancreas, gallbladder, part of duodenum, pylorus of the stomach, and lymph nodes near the pancreatic head. The surgeon reconnects the remaining pancreas and digestive organs so that pancreatic digestive enzymes, bile, and stomach contents will flow into the SI during digestion. Pyloric-sparing whipples are a variant of this procedure.		A standard whipple consists of resection of head of pancreas, gallbladder, part of duodenum, pylorus of the stomach, and lymph nodes near the pancreatic head. The surgeon reconnects the remaining pancreas and digestive organs so that pancreatic digestive enzymes, bile, and stomach contents will flow into the SI during digestion. Pyloric-sparing whipples are a variant of this procedure.
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	[[Category:Surgical procedures]]		[[Category:Surgical procedures]]
			[[Category:General surgery]]
			[[Category:Pancreatic surgery]]

Oliviamsutton at 15:21, 14 March 2022

2022-03-14T15:21:29Z

← Older revision		Revision as of 08:21, 14 March 2022
Line 10:		Line 10:

	The Pancreaticoduodenectomy is also known as the Whipple Procedure, after Dr. Allen Whipple. This is the most commonly performed surgery to remove pancreatic tumors, and is typically done for patients who have tumors located in the head of the pancreas or adjacent regions. The procedure is anatomically complicated, and there may be anatomical variations among the various involved blood vessels and ducts in the area. Even after pancreatic resection, the 5-year survival rate is only 15-20% (compared with 5% without surgery).		The Pancreaticoduodenectomy is also known as the Whipple Procedure, after Dr. Allen Whipple. This is the most commonly performed surgery to remove pancreatic tumors, and is typically done for patients who have tumors located in the head of the pancreas or adjacent regions. The procedure is anatomically complicated, and there may be anatomical variations among the various involved blood vessels and ducts in the area. Even after pancreatic resection, the 5-year survival rate is only 15-20% (compared with 5% without surgery).

			A standard whipple consists of resection of head of pancreas, gallbladder, part of duodenum, pylorus of the stomach, and lymph nodes near the pancreatic head. The surgeon reconnects the remaining pancreas and digestive organs so that pancreatic digestive enzymes, bile, and stomach contents will flow into the SI during digestion. Pyloric-sparing whipples are a variant of this procedure.

	== Preoperative management ==		== Preoperative management ==
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	=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===		=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===

			* A-line setup
			* Have insulin available in the room

	=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===		=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===

	*		* Many are ERAS pathway

	=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===		=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===

	* Preoperative epidural placement is common		* Preoperative epidural placement is common
			*TAP block can be administered if there is no epidural placement

	== Intraoperative management ==		== Intraoperative management ==

	=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===		=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===

			* A-line, 2 large-bore PIVs
			* CVP is not as common anymore
			* NG tube should be placed and taped for postop

	=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===		=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
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	=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===		=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===

			* Regular glucose checks and insulin infusion titration should occur throughout the procedure

	=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===		=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
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	=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===		=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===

			* ICU

	=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===		=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===

			* Epidural can be used for postoperative pain management

	=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===		=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===

			* Pulmonary complications occur following pancreatic resections in 25% of patients. Pulmonary recruitment is important with upper abdominal surgery
			** Pneumonia
			** Failure to wean from ventilator
			** Post-extubation respiratory failure represents mortality rate of 1-5%
			** Patients with pulmonary disease account for 40% of postoperative complications and 20% of deaths
			* Delayed gastric emptying: Usually at 7-10 days the stomach begins to recover function
			* Pancreatic fistula
			* Bowel leakage from anastomosis
			* Hemorrhage
			* Abscess
			* Pancreatogenic diabetes: Following pancreatic resection, insulin receptors are peripherally upregulated and patients are more sensitive to insulin. Patient is more prone to large swings in glucose.

	== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==		== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==
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	\|-		\|-
	\|Procedure		\|Procedure
	\|~~Resection of head of pancreas, gallbladder, part of duodenum, pylorus of the stomach, and lymph nodes near the pancreatic head.~~		\|Pylorus resected
	~~Surgeon reconnects the remaining pancreas and digestive organs so that pancreatic digestive enzymes, bile, and stomach contents will flow into the SI during digestion~~
	\|The pylorus is not resected		\|The pylorus is not resected
	\|-		\|-
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	\|-		\|-
	\|Surgical time		\|Surgical time
	\|		\|4-7h
	\|		\|4-7h
	\|-		\|-
	\|EBL		\|EBL
	\|		\|200-800cc
	\|		\|200-800cc
	\|-		\|-
	\|Postoperative disposition		\|Postoperative disposition

Oliviamsutton at 15:10, 14 March 2022

2022-03-14T15:10:37Z

← Older revision		Revision as of 08:10, 14 March 2022
Line 26:		Line 26:
	\|-		\|-
	\|Pulmonary		\|Pulmonary
	\|		\|Many pancreatic cancer patients have been heavy smokers, increased risk of pulmonary complications
	\|-		\|-
	\|Gastrointestinal		\|Gastrointestinal
	\|		\|Check if patient has had a bowel prep, they may be dry
	\|-		\|-
	\|Hematologic		\|Hematologic
	\|		\|Assess for anticoagulation and possible contraindications to an epidural. DVTs/PEs are major common complications of pancreatic cancer patients
	\|-		\|-
	\|Renal		\|Renal
Line 38:		Line 38:
	\|-		\|-
	\|Endocrine		\|Endocrine
	\|		\|80% have either diabetes or impaired glucose tolerance. Diabetics are at increased risk of MI, CVA, renal infarction
	\|-		\|-
	\|Other		\|Other
	\|		\|Pancreatitis patients tend to be hypotensive and hypovolemic
			More than 80% of pancreatic cancers are diagnosed in patients >65y/o with comorbidities.
	\|}		\|}

Line 48:		Line 49:
	* CBC, BMP, LFTs, coags		* CBC, BMP, LFTs, coags
	* EKG in any patient with risk factors for CAD		* EKG in any patient with risk factors for CAD
			*Type and Screen, have 2 units of pRBC on hold

	=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===		=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===

	=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===		=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===

			*

	=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===		=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===

			* Preoperative epidural placement is common

	== Intraoperative management ==		== Intraoperative management ==
Line 80:		Line 86:
	\|+		\|+
	!		!
	!~~Variant 1~~		!Standard Whipple
	!~~Variant 2~~		!Pylorus Preserving Whipple
	\|-		\|-
	\|~~Unique considerations~~		\|Procedure
	\|		\|Resection of head of pancreas, gallbladder, part of duodenum, pylorus of the stomach, and lymph nodes near the pancreatic head.
	\|		Surgeon reconnects the remaining pancreas and digestive organs so that pancreatic digestive enzymes, bile, and stomach contents will flow into the SI during digestion
			\|The pylorus is not resected
	\|-		\|-
	\|Position		\|Position

Oliviamsutton at 14:50, 14 March 2022

2022-03-14T14:50:31Z

← Older revision		Revision as of 07:50, 14 March 2022
Line 9:		Line 9:
	}}		}}

	~~Provide a brief summary~~ of ~~this surgical~~ procedure and ~~its indications here~~.		The Pancreaticoduodenectomy is also known as the Whipple Procedure, after Dr. Allen Whipple. This is the most commonly performed surgery to remove pancreatic tumors, and is typically done for patients who have tumors located in the head of the pancreas or adjacent regions. The procedure is anatomically complicated, and there may be anatomical variations among the various involved blood vessels and ducts in the area. Even after pancreatic resection, the 5-year survival rate is only 15-20% (compared with 5% without surgery).

	== Preoperative management ==		== Preoperative management ==
Line 45:		Line 45:

	=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===		=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===

			* CBC, BMP, LFTs, coags
			* EKG in any patient with risk factors for CAD

	=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===		=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===

Chris.Rishel: Text replacement - "|Respiratory" to "|Pulmonary"

2022-02-22T05:47:09Z

Text replacement - "|Respiratory" to "|Pulmonary"

← Older revision		Revision as of 22:47, 21 February 2022
Line 25:		Line 25:
	\|		\|
	\|-		\|-
	\|~~Respiratory~~		\|Pulmonary
	\|		\|
	\|-		\|-

Barrett.Larson at 23:42, 20 September 2021

2021-09-20T23:42:39Z

← Older revision		Revision as of 16:42, 20 September 2021
Line 2:		Line 2:
	\| anesthesia_type = General		\| anesthesia_type = General
	\| airway = ETT		\| airway = ETT
	\| lines_access =		\| lines_access = PIV x 2 <br/> ART
	\| monitors = Standard <br/> 5-lead EKG <br/> ABP <br/> +/- CVP		\| monitors = Standard <br/> 5-lead EKG <br/> ABP <br/> +/- CVP
	\| considerations_preoperative =		\| considerations_preoperative = Mechanical bowel prep <br/> ERAS
	\| considerations_intraoperative =		\| considerations_intraoperative = Combined general + epidural<br/> Goal-directed fluid therapy <br/> Glucose control <br/> Blood transfusion management <br/> Lung protective ventilation <br/> Avoid hypothermia
	\| considerations_postoperative =		\| considerations_postoperative = PONV <br/> ERAS <br/> Goal-directed fluid therapy <br/> Early NG, foley, and drain removal <br/> Early PO nutrition <br/> Glycemic control<br/> Non-opioid analgesia <br/> DVT PPx <br/> Pulmonary rehab <br/> Early ambulation
	}}		}}

Barrett.Larson at 23:32, 20 September 2021

2021-09-20T23:32:49Z

← Older revision	Revision as of 16:32, 20 September 2021
Line 1:	Line 1:
		{{Infobox surgical procedure
		\| anesthesia_type = General
		\| airway = ETT
		\| lines_access =
		\| monitors = Standard <br/> 5-lead EKG <br/> ABP <br/> +/- CVP
		\| considerations_preoperative =
		\| considerations_intraoperative =
		\| considerations_postoperative =
		}}

		Provide a brief summary of this surgical procedure and its indications here.

		== Preoperative management ==

		=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===
		{\| class="wikitable"
		\|+
		!System
		!Considerations
		\|-
		\|Neurologic
		\|
		\|-
		\|Cardiovascular
		\|
		\|-
		\|Respiratory
		\|
		\|-
		\|Gastrointestinal
		\|
		\|-
		\|Hematologic
		\|
		\|-
		\|Renal
		\|
		\|-
		\|Endocrine
		\|
		\|-
		\|Other
		\|
		\|}

		=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===

		=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===

		=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===

		=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===

		== Intraoperative management ==

		=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===

		=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===

		=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===

		=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===

		=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===

		== Postoperative management ==

		=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===

		=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===

		=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===

		== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==

		{\| class="wikitable wikitable-horizontal-scroll"
		\|+
		!
		!Variant 1
		!Variant 2
		\|-
		\|Unique considerations
		\|
		\|
		\|-
		\|Position
		\|
		\|
		\|-
		\|Surgical time
		\|
		\|
		\|-
		\|EBL
		\|
		\|
		\|-
		\|Postoperative disposition
		\|
		\|
		\|-
		\|Pain management
		\|
		\|
		\|-
		\|Potential complications
		\|
		\|
		\|}

		== References ==

		[[Category:Surgical procedures]]