Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content ++ 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. +++ Absolute ++ 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. +++ Relative ++ Cardiopulmonary comorbidities. ++ 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. ++ 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. ++ Delayed gastric emptying.Pancreatic leak.Surgical site infections.Gastroduodenal artery pseudoaneurysm. GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessAnesthesiology 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessAnesthesiology Full Site: One-Year Individual Subscription $995 USD Buy Now View All Subscription Options