Sections View Full Chapter Figures Tables Videos Annotate 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. Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth