Study Notes on Pancreaticoduodenectomy

CHAPTER 16

PART 2E: ALIMENTARY CANAL-ACCESSORY ORGAN PROCEDURES

STS2131 SURGICAL SPECIALTIES I

OBJECTIVES (1 OF 2)

After studying this chapter, you will be able to:

  • Recognize the relevant anatomy and terminology as they relate to the surgical procedure.
  • Indicate the pathology related to general surgery procedures.
  • Recall the names and uses of general surgery instruments, supplies, and specialty equipment.
  • Determine the intraoperative preparations of the patient specific to the illustrative procedures.
OBJECTIVES (2 OF 2)

After studying this chapter, you will be able to:

  • Summarize the surgical steps of the illustrative general surgery procedures in this chapter.
  • Identify the purpose and expected outcomes of the illustrative procedures.
  • Determine the immediate postoperative care of the patient and possible complications of the illustrative procedures.
  • Determine any specific variations related to the preoperative, intraoperative, and postoperative care of the general surgery patient.
MEDICAL TERMINOLOGY
  • Prefixes: NA
  • Word Roots:
    • Pancreat/o: pancreas
    • Duoden/o: duodenum, first part of the small intestine
  • Suffixes:
    • -ectomy: surgical removal, cutting out
PANCREAS PHYSIOLOGY
  • The pancreas functions as an exocrine gland, playing a critical role in digestion by producing and secreting enzyme-rich pancreatic juices. These juices flow through ducts into the small intestine’s duodenum to break down food into absorbable nutrients.
PANCREATICODUODENECTOMY BASICS (1 OF 2)
  • Pancreaticoduodenectomy (also known as the Whipple procedure) is a complex surgical procedure aimed at removing:
    • the head of the pancreas,
    • the entire duodenum (which shares the same blood supply),
    • a portion of the jejunum,
    • the gallbladder,
    • the lower half of the common bile duct, and
    • the distal third of the stomach.
PANCREATICODUODENECTOMY BASICS (2 OF 2)
  • Indications for performing a pancreaticoduodenectomy include localized pancreatic cancer.
  • The surgical approach can be executed via open surgery, laparoscopic techniques, or robotic assistance.
PANCREATICODUODENECTOMY PROCEDURE (1 OF 5)
  • The following equipment, instruments, and supplies are necessary for a pancreaticoduodenectomy:
    • Long and deep instruments,
    • Peripheral vascular instrument set,
    • Gallbladder instruments,
    • GI linear stapler,
    • Yankauer and Poole suction devices,
    • Hemaclip appliers,
    • Self-retaining abdominal retractors (such as Bookwalter).
PANCREATICODUODENECTOMY PROCEDURE (2 OF 5)
  • The surgical procedure is detailed between pages 535-543 and includes several preoperative considerations:
    • Positioning:
    • For open procedures, the patient is typically placed in a supine position.
    • For robotic procedures, the patient is also in a supine position, but with a 20-degree reverse Trendelenburg tilt and a slight left-side tilt to ensure stability (often utilizing a bean bag) and the legs are usually spread to provide access for the bedside assistant.
    • Anesthesia: A general anesthesia is utilized, typically referred to by the term "Superstar Surgical Tech."
PANCREATICODUODENECTOMY PROCEDURE (3 OF 5)
  • Continuing with preoperative considerations:
    • Skin Preparation: The skin should be cleansed from the mid-chest to mid-thigh regions, and bilaterally as far as feasible.
    • Draping:
    • Four towels are required for draping.
    • A laparotomy drape is also used to cover the surgical area.
PANCREATICODUODENECTOMY PROCEDURE (4 OF 5)
  • Intraoperative considerations:
    • The procedure can take approximately 5-6 hours, requiring the potential transfusion of multiple units of blood/blood products.
    • The surgical process involves 8 steps for resection and 3 steps for reconstruction:
    1. Pancreaticojejunostomy
    2. Hepaticojejunostomy
    3. Gastrojejunostomy
PANCREATICODUODENECTOMY PROCEDURE (5 OF 5)
  • Postoperative considerations:
    • The wound classification after surgery can fall into the following categories:
    • Class II: Clean-contaminated, indicating that the surgical site is relatively free of contamination but has been exposed to areas of the body that could introduce bacteria.
    • Class III: Contaminated, which occurs if spillage from the bowel or biliary tract happens during the procedure.
QUESTIONS

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