The Concepts Behind Whipple Procedure for Pancreatic Cancer

  • A pancreaticoduodenectomy, or Whipple procedure is a major surgical operation involving the removal of the head of the pancreas, the duodenum, the proximal jejunum, gallbladder, and part of the stomach (part of stomach is not in pylorus preserving whipple's).
  • The basic concept behind the pancreaticoduodenectomy is that the head of the pancreas and the duodenum share the same arterial blood supply (the gastroduodenal artery). 
  • These arteries run through the head of the pancreas, so that both organs must be removed if the single blood supply is severed. 
  • If only the head of the pancreas were removed it would compromise blood flow to the duodenum, resulting in tissue necrosis.
  • Reconstruction Sequence followed: Whipple originally used the sequence: bile duct, pancreas and stomach, whereas presently the popular method of reconstruction is pancreas, bile duct and stomach, also known as Child's operation.
  •  In recent years the pylorus-preserving pancreaticoduodenectomy (also known as Traverso-Longmire procedure/PPPD) has been gaining popularity. The main advantage of this technique is that the pylorus, and thus normal gastric emptying, is preserved.