Pancreaticoduodenectomy (Whipple Procedure)

Excerpt

Pancreaticoduodenectomy, commonly known as the Whipple procedure, is a complex and technically challenging surgery primarily used to treat malignancies in the pancreatic head, periampullary region, and distal bile duct. The procedure involves the resection of the pancreatic head and uncinate process, duodenum, proximal jejunum, distal bile duct, gallbladder, and usually part of the stomach, followed by restoring bilioenteric continuity (see Image. Pancreaticoduodenectomy [Whipple Procedure]). While predominantly performed for malignant conditions, it is also indicated for benign conditions like chronic pancreatitis, large symptomatic cysts, or premalignant lesions such as intrapancreatic mucinous neoplasms.

The procedure was first performed by Walter Kausch in Germany and later refined by Allen Whipple in the United States and has become a cornerstone in managing pancreatic and periampullary cancers. Advances in surgical techniques, including minimally invasive approaches like laparoscopy with or without robotic assistance, have improved outcomes, yet the Whipple procedure remains associated with significant morbidity and mortality. Successful outcomes hinge on meticulous patient selection, comprehensive preoperative preparation, skilled surgical and anesthetic techniques, and coordinated postoperative care.