Chapter 15. Pancreaticoduodenectomy

• 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.