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  • Malignant lesions involving the head of pancreas, ampulla of Vater, distal end of the common bile duct, or duodenum.
    • Absence of metastasis.
    • Absence of arterial involvement.
  • Refractory severe pain from chronic pancreatitis.
    • Refractory to medical therapy.
    • Repeat hospital admissions.
    • Majority of disease limited to the head of the pancreas.

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Absolute

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  • Evidence of metastatic disease.
  • Evidence of para-aortic nodes outside the field of dissection.
  • Involvement of the aorta or vena cava.
  • Involvement of the superior mesenteric artery, hepatic artery, or celiac axis.

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Relative

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  • Cardiopulmonary comorbidities.

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  • The patient should be supine.
  • The entire abdomen is shaved and prepped.
  • The abdomen is entered through a midline incision or bilateral subcostal "Chevron" incision, depending on surgeon preference.

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  • Nothing by mouth with nasogastric tube decompression.
  • Oral diet is advanced following removal of the nasogastric tube and once ileus has resolved, usually within 48–72 hours postoperatively.
  • Monitoring of abdominal drain fluids for evidence of a biliary or pancreatic leak.

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  • Delayed gastric emptying.
  • Pancreatic leak.
  • Surgical site infections.
  • Gastroduodenal artery pseudoaneurysm.

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