29:
134:
457:
approximately 17% of operations. During the surgery, a new biliary connection (normally a choledochal-jejunal anastamosis connecting the common bile duct and jejunum) is made. This new connection may leak in 1-2% of operations. As this complication is fairly common, it is normal in this procedure for the surgeon to leave a drain in place at the end. This allows for detection of a bile leak via elevated bilirubin in the fluid drained. Pancreatic leak or pancreatic fistula, defined as fluid drained after postoperative day 3 that has an
418:, and thus normal gastric emptying, should in theory be preserved. There is conflicting data as to whether pylorus-preserving pancreaticoduodenectomy is associated with increased likelihood of gastric emptying. In practice, it shows similar long-term survival as a Whipple's (pancreaticoduodenectomy + hemigastrectomy), but patients benefit from improved recovery of weight after a PPPD, so this should be performed when the tumour does not involve the stomach and the lymph nodes along the gastric curvatures are not enlarged.
204:. The reason for the removal of the duodenum along with the head of the pancreas is that they share the same arterial blood supply (the superior pancreaticoduodenal artery and inferior pancreaticoduodenal artery). These arteries run through the head of the pancreas so that both organs must be removed if the single blood supply is severed. If only the head of the pancreas were removed it would compromise blood flow to the duodenum, resulting in tissue
142:
485:
of the intestine, is a physiologic response to abdominal surgery, including the
Whipple procedure. While post-operative ileus is typically self-limited, prolonged post-operative ileus occurs when patients develop nausea, abdominal distention, pain or intolerance of food by mouth. Various measures are
456:
Three of the most common post-operative complications are delayed gastric emptying, bile leak, and pancreatic leak. Delayed gastric emptying, normally defined as an inability to tolerate a regular diet by the end of the first post-op week and the requirement for nasogastric tube placement, occurs in
421:
Compared to the standard
Whipple procedure, the pylorus preserving pancreaticoduodenectomy technique is associated with shorter operation time and less intraoperative blood loss, requiring less blood transfusion. Post-operative complications, hospital mortality and survival do not differ between the
372:
Metastatic disease is another contradiction to surgery. It most often occurs in the peritoneum, in the liver, and in the omentum. In order to determine if there are metastases, surgeons will inspect the abdomen at the beginning of the procedure after gaining access. Alternatively, they may perform a
354:
is uncommon. In rare cases when this pattern of trauma has been reported, it has been seen as a result of a lap belt in motor vehicle accidents. Pancreaticoduodenectomy has been performed when abdominal trauma has resulted in bleeding around the pancreas and duodenum, damage to the common bile duct,
444:
to be four times higher (16.3 v. 3.8%) at low-volume (averaging less than one pancreaticoduodenectomy per year) hospitals than at high-volume (16 or more per year) hospitals. Even at high-volume hospitals, morbidity has been found to vary by a factor of almost four depending on the number of times
215:
is removed. This means that while the liver remains with a good blood supply the surgeon must make a new connection to drain bile produced in the liver. This is done at the end of the surgery. The surgeon will make a new attachment between the pancreatic duct and the jejunum or stomach. During the
291:, which aims to shrink the tumor and increase the likelihood of complete resection. Post-operative death and complications associated with pancreaticoduodenectomy have become less common, with rates of post-operative mortality falling from 30 to 10% in the 1980s to less than 5% in the 2000s.
377:
which involves insertion of a small camera through a small incision to look inside the abdomen. This may spare the patient the large abdominal incision that would occur if they were to undergo the initial part of a pancreaticoduodenectomy that was cancelled due to metastatic disease.
255:, which includes cancer of the bile duct, duodenum, ampulla or head of the pancreas. The shared blood supply of the pancreas, duodenum and common bile duct necessitates en bloc resection of these multiple structures. Other indications for pancreaticoduodenectomy include
1408:
Karanicolas PJ, Davies E, Kunz R, Briel M, Koka HP, Payne DM, et al. (June 2007). "The pylorus: take it or leave it? Systematic review and meta-analysis of pylorus-preserving versus standard whipple pancreaticoduodenectomy for pancreatic or periampullary cancer".
322:, is an indication for the Whipple procedure when the cancer is present in the distal biliary system, usually the common bile duct that drains into the duodenum. Depending on the location and extension of the cholangiocarcinoma, curative surgical resection may require
406:. Sometimes the pancreaticojejunostomy may not hold properly after the completion of the operation and infection may spread inside the patient. This may lead to another operation shortly thereafter in which the remainder of the pancreas (and sometimes the
169:
in the area are often removed during the operation as well (lymphadenectomy). However, not all lymph nodes are removed in the most common type of pancreaticoduodenectomy because studies showed that patients did not benefit from the more extensive surgery.
363:
In order to be considered for surgical removal, the tumor cannot encase more than 50% of any of the following vessels: the celiac artery, superior mesenteric artery, or inferior vena cava. In cases where less than 50% of the vessel is involved,
433:
Many studies have shown that hospitals where a given operation is performed more frequently have better overall results (especially in the case of more complex procedures, such as pancreaticoduodenectomy). A frequently cited study published in
368:
remove the involved portion of the vessel, and repair the residual artery or vein. Tumors are still borderline resectable even if they involve the superior mesenteric or portal veins, gastroduodenal artery, superior mesenteric vein or colon.
1643:
Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. (November 2007). "Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the
International Study Group of Pancreatic Surgery (ISGPS)".
414:. In recent years the pylorus-preserving pancreaticoduodenectomy (also known as Traverso-Longmire procedure/PPPD) has been gaining popularity, especially among European surgeons. The main advantage of this technique is that the
1501:
Iqbal N, Lovegrove RE, Tilney HS, Abraham AT, Bhattacharya S, Tekkis PP, Kocher HM (November 2008). "A comparison of pancreaticoduodenectomy with pylorus preserving pancreaticoduodenectomy: a meta-analysis of 2822 patients".
342:. Intractable abdominal pain is the main surgical indication for surgical management of chronic pancreatitis. Removal of the head of the pancreas can relieve pancreatic duct obstruction associated with chronic pancreatitis.
461:
content greater than or equal to 3 times the upper limit of normal, occurs in 5-10% of operations, although changes in the definition of fistula may now include a much larger proportion of patients (upwards of 40%).
659:
Sun J, Yang Y, Wang X, Yu Z, Zhang T, Song J, et al. (October 2014). "Meta-analysis of the efficacies of extended and standard pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas".
445:
the surgeon has previously performed the procedure. de Wilde et al. have reported statistically significant mortality reductions concurrent with centralization of the procedure in the
Netherlands.
28:
177:
and the liver are inspected for disease that has metastasized. This is an important first step as the presence of active metastatic disease is a contraindication to performing the operation.
1141:
Gulla A, Tan WP, Pucci MJ, Dambrauskas Z, Rosato EL, Kaulback KR, et al. (January 2014). "Emergent pancreaticoduodenectomy: a dual institution experience and review of the literature".
1882:
Sugawara K, Kawaguchi Y, Nomura Y, Suka Y, Kawasaki K, Uemura Y, et al. (March 2018). "Perioperative
Factors Predicting Prolonged Postoperative Ileus After Major Abdominal Surgery".
2108:
355:
pancreatic leakage, or transection of the duodenum. Due to the rarity of this procedure in the setting of trauma, there is not robust evidence regarding post-operative outcomes.
1763:
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. (July 2005). "Postoperative pancreatic fistula: an international study group (ISGPF) definition".
1286:
Testini M, Regina G, Todisco C, Verzillo F, Di Venere B, Nacchiero M (September 1998). "An unusual complication resulting from surgical treatment of periampullary tumours".
1315:"Pylorus-preserving pancreaticoduodenectomy (pp Whipple) versus pancreaticoduodenectomy (classic Whipple) for surgical treatment of periampullary and pancreatic carcinoma"
3009:
1454:"A systematic review and meta-analysis of pylorus-preserving versus classical pancreaticoduodenectomy for surgical treatment of periampullary and pancreatic carcinoma"
546:
are often used interchangeably in the medical literature, scrutinizing their etymology yields different definitions for the two terms. As a result, the authors prefer
307:
Duodenal cancer arises from the lining of the duodenal mucosa. Majority of duodenal cancers originate in the second part of the duodenum, where ampulla is located.
2780:
951:
Tsuchikawa T, Hirano S, Okamura K, Matsumoto J, Tamoto E, Murakami S, et al. (March 2015). "Advances in the surgical treatment of hilar cholangiocarcinoma".
109:. Due to the shared blood supply of organs in the proximal gastrointestinal system, surgical removal of the head of the pancreas also necessitates removal of the
2741:
1835:"Moving towards the New International Study Group for Pancreatic Surgery (ISGPS) definitions in pancreaticoduodenectomy: a comparison between the old and new"
381:
Further contraindications include encasement of major vessels (such as celiac artery, inferior vena cava, or superior mesenteric artery) as mentioned above.
2806:
448:
One study reported actual risk to be 2.4 times greater than the risk reported in the medical literature, with additional variation by type of institution.
3045:
2076:
The
Toronto Video Atlas of Liver, Pancreas and Transplant Surgery Patient Education Module – Patient and Family Education video for the Whipple procedure
1537:
133:
2811:
2101:
591:
Fingerhut A, Vassiliu P, Dervenis C, Alexakis N, Leandros E (September 2007). "What is in a word: Pancreatoduodenectomy or pancreaticoduodenectomy?".
1798:
Cullen JJ, Sarr MG, Ilstrup DM (October 1994). "Pancreatic anastomotic leak after pancreaticoduodenectomy: incidence, significance, and management".
490:
is typically maintained to suction, to drain gastric and intestinal contents. Ambulation is encouraged to stimulate return of bowel function. Use of
2547:
1608:
Syin D, Woreta T, Chang DC, Cameron JL, Pronovost PJ, Makary MA (November 2007). "Publication bias in surgery: implications for informed consent".
2704:
243:. These structures are important to consider in this operation especially if done for resection of a tumor located in the head of the pancreas.
52:
996:"Surgical strategies in the treatment of chronic pancreatitis: An updated systematic review and meta-analysis of randomized controlled trials"
2259:
2094:
287:
or locally advanced un-resectable disease; thus only 15–20% of patients are candidates for the
Whipple procedure. Surgery may follow
2308:
436:
193:
185:
470:
Immediately after surgery, patients are monitored for return of bowel function and appropriate closed-suction drainage of the abdomen.
2746:
2080:
527:
3004:
2999:
339:
754:
2537:
633:
2244:
2195:
268:
2218:
1094:"Trauma Whipple: do or don't after severe pancreaticoduodenal injuries? An analysis of the National Trauma Data Bank (NTDB)"
1176:
756:, Lillemoe K, Loehrer A. Whipple procedure for multiple endocrine neoplasia of the pancreas. J Med Ins. 2018;2018(16). doi:
2626:
2370:
1545:
2892:
2611:
2438:
2384:
2315:
2144:
2135:
840:
Wolff RA (February 2018). "Adjuvant or
Neoadjuvant Therapy in the Treatment in Pancreatic Malignancies: Where Are We?".
2180:
2801:
2636:
153:
removal of the distal segment (antrum) of the stomach, the first and second portions of the duodenum, the head of the
877:"Postoperative complications and overall survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma"
3055:
3050:
2709:
2631:
2499:
2358:
236:
189:
173:
At the very beginning of the procedure, after the surgeons have gained access to the abdomen, the surfaces of the
2897:
2687:
2601:
2509:
2428:
2200:
2190:
2075:
1365:
Michalski CW, Weitz J, BĂĽchler MW (September 2007). "Surgery insight: surgical management of pancreatic cancer".
567:
1968:
Vather R, Bissett I (May 2013). "Management of prolonged post-operative ileus: evidence-based recommendations".
227:
Relevant nearby anatomy not removed during the procedure include the major vascular structures in the area: the
2991:
2846:
2504:
2185:
2127:
288:
232:
59:
2940:
2481:
2239:
2086:
1559:
de Wilde RF, Besselink MG, van der Tweel I, de Hingh IH, van Eijck CH, Dejong CH, et al. (March 2012).
2970:
2785:
2249:
2118:
2070:
487:
351:
1679:
Traverso LW, Hashimoto Y (2008). "Delayed gastric emptying: the state of the highest level of evidence".
2945:
2875:
2731:
2325:
2286:
3014:
2011:
Schnelldorfer T, Sarr MG (December 2009). "Alessandro
Codivilla and the first pancreatoduodenectomy".
1092:
van der Wilden GM, Yeh D, Hwabejire JO, Klein EN, Fagenholz PJ, King DR, et al. (February 2014).
2542:
503:
398:, mostly because patients who submit to this operation tend to develop a particularly severe form of
395:
335:
256:
252:
197:
2066:
Toronto
Whipple Clinical Pathway Education App - Open access App for patient and caregiver education
875:
Pugalenthi A, Protic M, Gonen M, Kingham TP, Angelica MI, Dematteo RP, et al. (February 2016).
2917:
2841:
2736:
2641:
2616:
2532:
2527:
2471:
2266:
1313:
HĂĽttner FJ, Fitzmaurice C, Schwarzer G, Seiler CM, Antes G, BĂĽchler MW, Diener MK (February 2016).
558:
should refer to the resection of the duodenum and pancreatic duct rather than the pancreas itself.
1045:"Duodenum-preserving pancreatic resection versus pancreaticoduodenectomy for chronic pancreatitis"
2411:
2254:
1993:
1950:
1907:
1590:
1434:
1390:
1123:
976:
685:
315:
240:
1716:"Computed tomography evaluation of early post-operative complications of the Whipple procedure"
2977:
2861:
2823:
2669:
2579:
2401:
2293:
2234:
2071:
The Toronto Video Atlas of Liver, Pancreas and Transplant Surgery – Video of Whipple procedure
2028:
1985:
1942:
1899:
1864:
1815:
1780:
1745:
1696:
1661:
1625:
1582:
1519:
1483:
1426:
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1235:
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1115:
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1025:
968:
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857:
822:
787:
737:
677:
608:
399:
365:
280:
94:
47:
2981:
2818:
2224:
2020:
1977:
1934:
1891:
1854:
1846:
1807:
1772:
1735:
1727:
1688:
1653:
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1511:
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1007:
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719:
669:
600:
507:
403:
260:
212:
158:
805:
O Kane GM, Knox JJ (2017-11-16). "Locally advanced pancreatic cancer: An emerging entity".
486:
taken in the immediate post-operative period to minimize prolonged post-operative ileus. A
3019:
2796:
2792:
2775:
2770:
2557:
2453:
2443:
2418:
2406:
2393:
2345:
818:
430:
Pancreaticoduodenectomy is considered, by any standard, to be a major surgical procedure.
217:
33:
The pancreas, stomach, and bowel are joined back together after a pancreaticoduodenectomy
2051:
3024:
2851:
2714:
2659:
2365:
2335:
2229:
2170:
2153:
1859:
1834:
1740:
1715:
1478:
1469:
1453:
1339:
1314:
1230:
1203:
1069:
1044:
1020:
995:
927:
901:
876:
732:
723:
707:
511:
441:
1811:
1561:"Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality"
3039:
2935:
2664:
2594:
2330:
2165:
1850:
1127:
523:
201:
181:
1997:
1954:
1594:
1452:
Diener MK, Knaebel HP, Heukaufer C, Antes G, BĂĽchler MW, Seiler CM (February 2007).
1438:
980:
689:
2912:
2726:
2621:
2606:
2461:
2083:– The original description of Whipple's operation together with a modern commentary
1911:
1394:
1330:
1060:
106:
964:
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in New York and subsequently came up with multiple refinements to his technique.
65:
2902:
2758:
2721:
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2320:
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482:
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228:
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162:
118:
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1515:
1254:
604:
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2519:
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2024:
1895:
1692:
1621:
1422:
1154:
1110:
1093:
928:"Periampullary Cancer: Symptoms, Staging & Treatment | Dr. Nikhil Agrawal"
853:
783:
673:
284:
264:
224:. This portion is not done en bloc, as the gallbladder is removed separately.
174:
166:
141:
2762:
2565:
2476:
2466:
2423:
2353:
2157:
394:
Clinical trials have failed to demonstrate significant survival benefits of
326:, or removal of part of the liver, with or without pancreaticoduodenectomy.
319:
251:
Pancreaticoduodenectomy is most often performed as a curative treatment for
2032:
1989:
1903:
1868:
1784:
1749:
1731:
1700:
1665:
1629:
1586:
1523:
1487:
1430:
1386:
1348:
1266:
1239:
1220:
1162:
1119:
1078:
1029:
972:
910:
861:
826:
791:
741:
681:
612:
16:
Major surgical procedure involving the pancreas, duodenum, and other organs
1946:
1819:
1299:
279:
Pancreaticoduodenectomy is the only potentially curative intervention for
150:
2833:
2574:
2081:"Whipple pancreaticoduodenectomy: a historical comment Adrian O'Sullivan"
205:
154:
110:
102:
98:
283:. However, the majority of patients with pancreatic cancer present with
75:
2210:
1938:
1378:
458:
415:
411:
149:
The most common technique of a pancreaticoduodenectomy consists of the
122:
114:
1981:
892:
2927:
2491:
1577:
1560:
491:
407:
757:
2696:
478:
140:
132:
42:
Pancreatoduodenectomy, Whipple procedure, Kausch-Whipple procedure
1925:
Livingston EH, Passaro EP (January 1990). "Postoperative ileus".
410:) is removed to prevent further spread of infection and possible
299:
Ampullary cancer arises from the lining of the ampulla of Vater.
526:
who devised an improved version of the surgery in 1935 while at
2090:
1043:
Gurusamy KS, Lusuku C, Halkias C, Davidson BR (February 2016).
93:, is a major surgical operation most often performed to remove
1202:
Zakharova, OP; Karmazanovsky, GG; Egorov, VI (27 May 2012).
2065:
634:"Surgical resection of lesions of the head of the pancreas"
770:
Clancy TE (August 2015). "Surgery for Pancreatic Cancer".
706:
Cameron JL, Riall TS, Coleman J, Belcher KA (July 2006).
514:
in 1909 and described by him in 1912. It is often called
506:, an Italian surgeon, in 1898. The first resection for a
267:
to the pancreas, multiple endocrine neoplasia type 1 and
196:. There are additional smaller branches given off by the
494:, which interfere with intestinal motility, is limited.
211:
While the blood supply to the liver is left intact, the
554:
for the name of this procedure, as strictly speaking
101:. It is also used for the treatment of pancreatic or
708:"One thousand consecutive pancreaticoduodenectomies"
2990:
2958:
2926:
2883:
2874:
2832:
2757:
2695:
2686:
2650:
2556:
2518:
2490:
2452:
2392:
2383:
2344:
2209:
2152:
2143:
2134:
1544:. Harvard Health Publications. 2009. Archived from
137:
The tissue removed during a pancreaticoduodenectomy
58:
46:
38:
21:
953:Expert Review of Gastroenterology & Hepatology
632:
338:typically includes pain control and management of
1204:"Pancreatic adenocarcinoma: Outstanding problems"
1360:
1358:
180:The vascular supply of the pancreas is from the
1261:. Treasure Island (FL): StatPearls Publishing.
2742:Transjugular intrahepatic portosystemic shunt
2102:
8:
1681:Journal of Hepato-Biliary-Pancreatic Surgery
772:Hematology/Oncology Clinics of North America
538:Fingerhut et al. argue that while the terms
481:, which refers to functional obstruction or
1319:The Cochrane Database of Systematic Reviews
1049:The Cochrane Database of Systematic Reviews
994:Zhao X, Cui N, Wang X, Cui Y (March 2017).
586:
584:
582:
510:cancer was performed by the German surgeon
502:This procedure was originally described by
2880:
2692:
2389:
2149:
2140:
2109:
2095:
2087:
27:
1858:
1739:
1576:
1477:
1338:
1253:D'Cruz JR, Misra S, Shamsudeen S (2023).
1229:
1219:
1208:World Journal of Gastrointestinal Surgery
1109:
1068:
1019:
900:
731:
350:Damage to the pancreas and duodenum from
2548:Transanal hemorrhoidal dearterialization
2705:Artificial extracorporeal liver support
1833:Tan WJ, Kow AW, Liau KH (August 2011).
578:
390:Pylorus-sparing pancreaticoduodenectomy
373:separate procedure called a diagnostic
18:
1504:European Journal of Surgical Oncology
922:
920:
842:The Surgical Clinics of North America
819:10.1016/j.currproblcancer.2017.10.006
701:
699:
7:
2260:Vertical banded gastroplasty surgery
626:
624:
622:
528:Columbia-Presbyterian Medical Center
2309:Percutaneous endoscopic gastrostomy
2117:Tests and procedures involving the
1884:Journal of Gastrointestinal Surgery
437:The New England Journal of Medicine
194:inferior pancreaticoduodenal artery
186:superior pancreaticoduodenal artery
71:
2747:Distal splenorenal shunt procedure
1470:10.1097/01.sla.0000242711.74502.a9
1367:Nature Clinical Practice. Oncology
724:10.1097/01.sla.0000217673.04165.ea
14:
3046:Accessory digestive gland surgery
129:Anatomy involved in the procedure
121:, and, occasionally, part of the
1851:10.1111/j.1477-2574.2011.00336.x
1610:The Journal of Surgical Research
1542:Pri-Med Patient Education Center
1143:The Journal of Surgical Research
758:https://doi.org/10.24296/jomi/16
281:malignant tumors of the pancreas
2538:Lateral internal sphincterotomy
1927:Digestive Diseases and Sciences
269:gastrointestinal stromal tumors
200:which is also derived from the
2245:Endoscopic sleeve gastroplasty
2196:Functional Lumen Imaging Probe
1565:The British Journal of Surgery
1331:10.1002/14651858.CD006053.pub6
1061:10.1002/14651858.CD011521.pub2
1:
2627:Lower gastrointestinal series
2371:Upper gastrointestinal series
1812:10.1016/s0002-9610(05)80151-5
1714:Emekli E, GĂĽndoÄźdu E (2020).
522:, after the American surgeon
261:benign tumors of the pancreas
97:tumours from the head of the
2893:Diagnostic peritoneal lavage
2612:Double-contrast barium enema
2439:Partial ileal bypass surgery
2316:Esophagogastric dissociation
965:10.1586/17474124.2015.960393
881:Journal of Surgical Oncology
2710:Bioartificial liver devices
2637:Transrectal ultrasonography
1800:American Journal of Surgery
1720:Polish Journal of Radiology
1411:Annals of Surgical Oncology
1012:10.1097/MD.0000000000006220
631:Reber H (24 October 2016).
452:Postoperative complications
220:is performed to remove the
3072:
2632:Small-bowel follow-through
2500:Abdominoperineal resection
2359:Esophagogastroduodenoscopy
1777:10.1016/j.surg.2005.05.001
1658:10.1016/j.surg.2007.05.005
1516:10.1016/j.ejso.2007.12.004
1177:"Pancreatic Cancer Stages"
807:Current Problems in Cancer
605:10.1016/j.surg.2007.06.002
237:superior mesenteric artery
190:superior mesenteric artery
2992:Clinical prediction rules
2898:Intraperitoneal injection
2602:Abdominal ultrasonography
2510:Total mesorectal excision
2429:Intestine transplantation
2219:Sengstaken–Blakemore tube
2201:High resolution manometry
2191:Esophageal motility study
2125:
2025:10.1001/archsurg.2009.219
1896:10.1007/s11605-017-3622-8
1693:10.1007/s00534-007-1304-8
1622:10.1016/j.jss.2007.03.035
1423:10.1245/s10434-006-9330-3
1255:"Pancreaticoduodenectomy"
1183:. American Cancer Society
1155:10.1016/j.jss.2013.07.057
1111:10.1007/s00268-013-2257-5
854:10.1016/j.suc.2017.09.009
784:10.1016/j.hoc.2015.04.001
674:10.1007/s00268-014-2633-9
568:List of surgeries by type
72:
26:
2847:Pancreas transplantation
2505:Lower anterior resection
2186:Esophageal pH monitoring
2128:Digestive system surgery
1098:World Journal of Surgery
662:World Journal of Surgery
474:Return of bowel function
289:neoadjuvant chemotherapy
233:superior mesenteric vein
2941:Inguinal hernia surgery
2857:Pancreaticoduodenectomy
2240:Adjustable gastric band
2181:Impedance–pH monitoring
1538:"The Whipple Procedure"
556:pancreaticoduodenectomy
552:pancreaticoduodenectomy
544:pancreaticoduodenectomy
426:Morbidity and mortality
385:Surgical considerations
87:pancreaticoduodenectomy
22:Pancreaticoduodenectomy
2971:Exploratory laparotomy
2786:Hepatoportoenterostomy
2250:Gastric bypass surgery
2119:human digestive system
1970:ANZ Journal of Surgery
1732:10.5114/pjr.2020.93399
1221:10.4240/wjgs.v4.i5.104
466:Recovery after surgery
352:blunt abdominal trauma
340:exocrine insufficiency
146:
138:
2946:Femoral hernia repair
2732:Liver transplantation
2326:Nissen fundoplication
548:pancreatoduodenectomy
540:pancreatoduodenectomy
144:
136:
2543:Rubber band ligation
2482:Hartmann's operation
504:Alessandro Codivilla
396:total pancreatectomy
336:chronic pancreatitis
330:Chronic pancreatitis
257:chronic pancreatitis
253:periampullary cancer
198:right gastric artery
2918:Peritoneal dialysis
2737:Portal hypertension
2642:Virtual colonoscopy
2617:Endoanal ultrasound
2533:Anorectal manometry
2528:Anal sphincterotomy
2472:Colonic polypectomy
2267:Collis gastroplasty
2013:Archives of Surgery
516:Whipple's procedure
318:, or cancer of the
247:Medical indications
105:trauma, or chronic
2412:Jejunoileal bypass
2255:Sleeve gastrectomy
1939:10.1007/bf01537233
1379:10.1038/ncponc0925
492:opioid medications
316:Cholangiocarcinoma
311:Cholangiocarcinoma
241:inferior vena cava
147:
139:
89:, also known as a
3056:Surgical oncology
3051:Pancreatic cancer
3033:
3032:
2978:Rapid urease test
2954:
2953:
2870:
2869:
2862:Puestow procedure
2824:Cholescintigraphy
2682:
2681:
2678:
2677:
2670:Stool guaiac test
2580:Capsule endoscopy
2402:Bariatric surgery
2379:
2378:
2294:Gastroenterostomy
2235:Bariatric surgery
2019:(12): 1179–1184.
1982:10.1111/ans.12102
1510:(11): 1237–1245.
1458:Annals of Surgery
1288:Panminerva Medica
932:Dr.Nikhil Agrawal
893:10.1002/jso.24125
712:Annals of Surgery
668:(10): 2708–2715.
520:Whipple procedure
400:diabetes mellitus
366:vascular surgeons
359:Contraindications
275:Pancreatic cancer
91:Whipple procedure
83:
82:
3063:
3015:Child–Pugh score
2982:Urea breath test
2881:
2842:Frey's procedure
2819:Cholecystography
2693:
2390:
2225:Nasogastric tube
2150:
2141:
2111:
2104:
2097:
2088:
2054:
2043:
2037:
2036:
2008:
2002:
2001:
1965:
1959:
1958:
1922:
1916:
1915:
1879:
1873:
1872:
1862:
1830:
1824:
1823:
1795:
1789:
1788:
1760:
1754:
1753:
1743:
1726:(1): e104–e109.
1711:
1705:
1704:
1676:
1670:
1669:
1640:
1634:
1633:
1605:
1599:
1598:
1580:
1578:10.1002/bjs.8664
1556:
1550:
1549:
1548:on 27 July 2011.
1534:
1528:
1527:
1498:
1492:
1491:
1481:
1449:
1443:
1442:
1417:(6): 1825–1834.
1405:
1399:
1398:
1362:
1353:
1352:
1342:
1310:
1304:
1303:
1283:
1277:
1276:
1274:
1273:
1250:
1244:
1243:
1233:
1223:
1199:
1193:
1192:
1190:
1188:
1173:
1167:
1166:
1138:
1132:
1131:
1113:
1089:
1083:
1082:
1072:
1040:
1034:
1033:
1023:
991:
985:
984:
948:
942:
941:
939:
938:
924:
915:
914:
904:
872:
866:
865:
837:
831:
830:
802:
796:
795:
767:
761:
752:
746:
745:
735:
703:
694:
693:
656:
650:
649:
647:
645:
636:
628:
617:
616:
588:
488:nasogastric tube
440:found operative
404:brittle diabetes
295:Ampullary cancer
213:common bile duct
159:common bile duct
76:edit on Wikidata
68:
31:
19:
3071:
3070:
3066:
3065:
3064:
3062:
3061:
3060:
3036:
3035:
3034:
3029:
3020:Ranson criteria
2986:
2950:
2922:
2866:
2828:
2797:Cholangiography
2793:Medical imaging
2776:Cholecystostomy
2771:Cholecystectomy
2753:
2674:
2646:
2558:Medical imaging
2552:
2514:
2486:
2448:
2444:Strictureplasty
2419:Bowel resection
2407:Duodenal switch
2375:
2346:Medical imaging
2340:
2205:
2136:Digestive tract
2130:
2121:
2115:
2062:
2057:
2044:
2040:
2010:
2009:
2005:
1967:
1966:
1962:
1924:
1923:
1919:
1881:
1880:
1876:
1832:
1831:
1827:
1797:
1796:
1792:
1762:
1761:
1757:
1713:
1712:
1708:
1678:
1677:
1673:
1642:
1641:
1637:
1607:
1606:
1602:
1558:
1557:
1553:
1536:
1535:
1531:
1500:
1499:
1495:
1451:
1450:
1446:
1407:
1406:
1402:
1364:
1363:
1356:
1325:(2): CD006053.
1312:
1311:
1307:
1285:
1284:
1280:
1271:
1269:
1252:
1251:
1247:
1201:
1200:
1196:
1186:
1184:
1175:
1174:
1170:
1140:
1139:
1135:
1091:
1090:
1086:
1055:(2): CD011521.
1042:
1041:
1037:
993:
992:
988:
950:
949:
945:
936:
934:
926:
925:
918:
874:
873:
869:
839:
838:
834:
804:
803:
799:
769:
768:
764:
753:
749:
705:
704:
697:
658:
657:
653:
643:
641:
630:
629:
620:
590:
589:
580:
576:
564:
536:
500:
476:
468:
454:
442:mortality rates
428:
392:
387:
361:
348:
332:
313:
305:
303:Duodenal cancer
297:
277:
249:
218:cholecystectomy
145:Whipple surgery
131:
79:
64:
34:
17:
12:
11:
5:
3069:
3067:
3059:
3058:
3053:
3048:
3038:
3037:
3031:
3030:
3028:
3027:
3025:Milan criteria
3022:
3017:
3012:
3007:
3002:
2996:
2994:
2988:
2987:
2985:
2984:
2975:
2974:
2973:
2962:
2960:
2956:
2955:
2952:
2951:
2949:
2948:
2943:
2938:
2932:
2930:
2924:
2923:
2921:
2920:
2915:
2910:
2905:
2900:
2895:
2889:
2887:
2878:
2876:Abdominopelvic
2872:
2871:
2868:
2867:
2865:
2864:
2859:
2854:
2852:Pancreatectomy
2849:
2844:
2838:
2836:
2830:
2829:
2827:
2826:
2821:
2816:
2815:
2814:
2809:
2804:
2789:
2788:
2783:
2778:
2773:
2767:
2765:
2755:
2754:
2752:
2751:
2750:
2749:
2744:
2734:
2729:
2724:
2719:
2718:
2717:
2715:Liver dialysis
2712:
2701:
2699:
2690:
2684:
2683:
2680:
2679:
2676:
2675:
2673:
2672:
2667:
2662:
2660:Fecal fat test
2656:
2654:
2648:
2647:
2645:
2644:
2639:
2634:
2629:
2624:
2619:
2614:
2609:
2604:
2598:
2597:
2592:
2587:
2582:
2577:
2572:
2562:
2560:
2554:
2553:
2551:
2550:
2545:
2540:
2535:
2530:
2524:
2522:
2516:
2515:
2513:
2512:
2507:
2502:
2496:
2494:
2488:
2487:
2485:
2484:
2479:
2474:
2469:
2464:
2458:
2456:
2450:
2449:
2447:
2446:
2441:
2436:
2431:
2426:
2421:
2416:
2415:
2414:
2409:
2398:
2396:
2387:
2385:Lower GI tract
2381:
2380:
2377:
2376:
2374:
2373:
2368:
2366:Barium swallow
2363:
2362:
2361:
2350:
2348:
2342:
2341:
2339:
2338:
2336:Schilling test
2333:
2328:
2323:
2318:
2313:
2312:
2311:
2301:
2296:
2291:
2290:
2289:
2284:
2279:
2269:
2264:
2263:
2262:
2257:
2252:
2247:
2242:
2232:
2230:Gastric lavage
2227:
2222:
2215:
2213:
2207:
2206:
2204:
2203:
2198:
2193:
2188:
2183:
2178:
2173:
2171:Heller myotomy
2168:
2162:
2160:
2147:
2145:Upper GI tract
2138:
2132:
2131:
2126:
2123:
2122:
2116:
2114:
2113:
2106:
2099:
2091:
2085:
2084:
2078:
2073:
2068:
2061:
2060:External links
2058:
2056:
2055:
2038:
2003:
1976:(5): 319–324.
1960:
1933:(1): 121–132.
1917:
1890:(3): 508–515.
1874:
1845:(8): 566–572.
1825:
1806:(4): 295–298.
1790:
1755:
1706:
1687:(3): 262–269.
1671:
1652:(5): 761–768.
1635:
1600:
1571:(3): 404–410.
1551:
1529:
1493:
1464:(2): 187–200.
1444:
1400:
1373:(9): 526–535.
1354:
1305:
1294:(3): 219–222.
1278:
1245:
1194:
1168:
1133:
1104:(2): 335–340.
1084:
1035:
986:
959:(3): 369–374.
943:
916:
887:(2): 188–193.
867:
832:
797:
778:(4): 701–716.
762:
747:
695:
651:
618:
599:(3): 428–429.
577:
575:
572:
571:
570:
563:
560:
535:
532:
512:Walther Kausch
499:
496:
475:
472:
467:
464:
453:
450:
427:
424:
391:
388:
386:
383:
360:
357:
347:
344:
331:
328:
312:
309:
304:
301:
296:
293:
276:
273:
248:
245:
130:
127:
81:
80:
73:
70:
69:
62:
56:
55:
50:
44:
43:
40:
36:
35:
32:
24:
23:
15:
13:
10:
9:
6:
4:
3:
2:
3068:
3057:
3054:
3052:
3049:
3047:
3044:
3043:
3041:
3026:
3023:
3021:
3018:
3016:
3013:
3011:
3008:
3006:
3003:
3001:
2998:
2997:
2995:
2993:
2989:
2983:
2979:
2976:
2972:
2969:
2968:
2967:
2964:
2963:
2961:
2957:
2947:
2944:
2942:
2939:
2937:
2936:Hernia repair
2934:
2933:
2931:
2929:
2925:
2919:
2916:
2914:
2911:
2909:
2906:
2904:
2901:
2899:
2896:
2894:
2891:
2890:
2888:
2886:
2882:
2879:
2877:
2873:
2863:
2860:
2858:
2855:
2853:
2850:
2848:
2845:
2843:
2840:
2839:
2837:
2835:
2831:
2825:
2822:
2820:
2817:
2813:
2810:
2808:
2805:
2803:
2800:
2799:
2798:
2794:
2791:
2790:
2787:
2784:
2782:
2779:
2777:
2774:
2772:
2769:
2768:
2766:
2764:
2760:
2756:
2748:
2745:
2743:
2740:
2739:
2738:
2735:
2733:
2730:
2728:
2725:
2723:
2720:
2716:
2713:
2711:
2708:
2707:
2706:
2703:
2702:
2700:
2698:
2694:
2691:
2689:
2685:
2671:
2668:
2666:
2665:Fecal pH test
2663:
2661:
2658:
2657:
2655:
2653:
2649:
2643:
2640:
2638:
2635:
2633:
2630:
2628:
2625:
2623:
2620:
2618:
2615:
2613:
2610:
2608:
2605:
2603:
2600:
2599:
2596:
2595:Sigmoidoscopy
2593:
2591:
2588:
2586:
2583:
2581:
2578:
2576:
2573:
2571:
2567:
2564:
2563:
2561:
2559:
2555:
2549:
2546:
2544:
2541:
2539:
2536:
2534:
2531:
2529:
2526:
2525:
2523:
2521:
2517:
2511:
2508:
2506:
2503:
2501:
2498:
2497:
2495:
2493:
2489:
2483:
2480:
2478:
2475:
2473:
2470:
2468:
2465:
2463:
2460:
2459:
2457:
2455:
2451:
2445:
2442:
2440:
2437:
2435:
2432:
2430:
2427:
2425:
2422:
2420:
2417:
2413:
2410:
2408:
2405:
2404:
2403:
2400:
2399:
2397:
2395:
2391:
2388:
2386:
2382:
2372:
2369:
2367:
2364:
2360:
2357:
2356:
2355:
2352:
2351:
2349:
2347:
2343:
2337:
2334:
2332:
2331:Pyloromyotomy
2329:
2327:
2324:
2322:
2319:
2317:
2314:
2310:
2307:
2306:
2305:
2302:
2300:
2297:
2295:
2292:
2288:
2285:
2283:
2280:
2278:
2275:
2274:
2273:
2270:
2268:
2265:
2261:
2258:
2256:
2253:
2251:
2248:
2246:
2243:
2241:
2238:
2237:
2236:
2233:
2231:
2228:
2226:
2223:
2220:
2217:
2216:
2214:
2212:
2208:
2202:
2199:
2197:
2194:
2192:
2189:
2187:
2184:
2182:
2179:
2177:
2174:
2172:
2169:
2167:
2166:Esophagectomy
2164:
2163:
2161:
2159:
2155:
2151:
2148:
2146:
2142:
2139:
2137:
2133:
2129:
2124:
2120:
2112:
2107:
2105:
2100:
2098:
2093:
2092:
2089:
2082:
2079:
2077:
2074:
2072:
2069:
2067:
2064:
2063:
2059:
2053:
2052:Who Named It?
2049:
2048:
2042:
2039:
2034:
2030:
2026:
2022:
2018:
2014:
2007:
2004:
1999:
1995:
1991:
1987:
1983:
1979:
1975:
1971:
1964:
1961:
1956:
1952:
1948:
1944:
1940:
1936:
1932:
1928:
1921:
1918:
1913:
1909:
1905:
1901:
1897:
1893:
1889:
1885:
1878:
1875:
1870:
1866:
1861:
1856:
1852:
1848:
1844:
1840:
1836:
1829:
1826:
1821:
1817:
1813:
1809:
1805:
1801:
1794:
1791:
1786:
1782:
1778:
1774:
1770:
1766:
1759:
1756:
1751:
1747:
1742:
1737:
1733:
1729:
1725:
1721:
1717:
1710:
1707:
1702:
1698:
1694:
1690:
1686:
1682:
1675:
1672:
1667:
1663:
1659:
1655:
1651:
1647:
1639:
1636:
1631:
1627:
1623:
1619:
1615:
1611:
1604:
1601:
1596:
1592:
1588:
1584:
1579:
1574:
1570:
1566:
1562:
1555:
1552:
1547:
1543:
1539:
1533:
1530:
1525:
1521:
1517:
1513:
1509:
1505:
1497:
1494:
1489:
1485:
1480:
1475:
1471:
1467:
1463:
1459:
1455:
1448:
1445:
1440:
1436:
1432:
1428:
1424:
1420:
1416:
1412:
1404:
1401:
1396:
1392:
1388:
1384:
1380:
1376:
1372:
1368:
1361:
1359:
1355:
1350:
1346:
1341:
1336:
1332:
1328:
1324:
1320:
1316:
1309:
1306:
1301:
1297:
1293:
1289:
1282:
1279:
1268:
1264:
1260:
1256:
1249:
1246:
1241:
1237:
1232:
1227:
1222:
1217:
1214:(5): 104–13.
1213:
1209:
1205:
1198:
1195:
1182:
1178:
1172:
1169:
1164:
1160:
1156:
1152:
1148:
1144:
1137:
1134:
1129:
1125:
1121:
1117:
1112:
1107:
1103:
1099:
1095:
1088:
1085:
1080:
1076:
1071:
1066:
1062:
1058:
1054:
1050:
1046:
1039:
1036:
1031:
1027:
1022:
1017:
1013:
1009:
1005:
1001:
997:
990:
987:
982:
978:
974:
970:
966:
962:
958:
954:
947:
944:
933:
929:
923:
921:
917:
912:
908:
903:
898:
894:
890:
886:
882:
878:
871:
868:
863:
859:
855:
851:
848:(1): 95–111.
847:
843:
836:
833:
828:
824:
820:
816:
812:
808:
801:
798:
793:
789:
785:
781:
777:
773:
766:
763:
759:
755:
751:
748:
743:
739:
734:
729:
725:
721:
717:
713:
709:
702:
700:
696:
691:
687:
683:
679:
675:
671:
667:
663:
655:
652:
640:
635:
627:
625:
623:
619:
614:
610:
606:
602:
598:
594:
587:
585:
583:
579:
573:
569:
566:
565:
561:
559:
557:
553:
549:
545:
541:
533:
531:
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25:
20:
2913:Paracentesis
2856:
2727:Liver biopsy
2622:Enteroclysis
2607:Defecography
2462:Appendectomy
2045:
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1616:(1): 88–93.
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1546:the original
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1270:. Retrieved
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1185:. Retrieved
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935:. Retrieved
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534:Nomenclature
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483:aperistalsis
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179:
172:
148:
107:pancreatitis
90:
86:
84:
2903:Laparoscopy
2759:Gallbladder
2722:Hepatectomy
2652:Stool tests
2590:Proctoscopy
2585:Enteroscopy
2570:Colonoscopy
2454:Large bowel
2434:Jejunostomy
2394:Small bowel
2321:Hill repair
2304:Gastrostomy
2282:Billroth II
2272:Gastrectomy
2176:Sialography
1771:(1): 8–13.
1187:13 December
375:laparoscopy
324:hepatectomy
229:portal vein
222:gallbladder
216:surgery, a
167:Lymph nodes
163:gallbladder
119:gallbladder
113:, proximal
39:Other names
3040:Categories
2966:Laparotomy
2908:Omentopexy
2885:Peritoneum
2520:Anal canal
2299:Gastropexy
2277:Billroth I
1272:2023-07-29
1259:StatPearls
1181:Cancer.org
1149:(1): 1–6.
937:2023-01-02
574:References
285:metastatic
265:metastatic
235:, and the
175:peritoneum
161:, and the
2763:bile duct
2688:Accessory
2566:Endoscopy
2477:Colostomy
2467:Colectomy
2424:Ileostomy
2354:Endoscopy
2287:Roux-en-Y
2158:Esophagus
2047:synd/3492
1128:206947730
412:morbidity
320:bile duct
263:, cancer
192:from the
95:cancerous
2834:Pancreas
2575:Anoscopy
2033:20026839
1998:28400301
1990:23418987
1955:27117157
1904:29119528
1869:21762300
1785:16003309
1750:32467744
1701:18535763
1666:17981197
1630:17950077
1595:11120876
1587:22237731
1524:18242943
1488:17245171
1439:23001824
1431:17342566
1387:17728711
1349:26905229
1267:32809582
1240:22655124
1163:24011528
1120:24121363
1079:26837472
1030:28248878
1000:Medicine
981:39664698
973:25256146
911:26678349
862:29191281
827:29153290
792:26226905
742:16794383
690:20402342
682:24912627
644:12 March
639:UpToDate
613:17723902
562:See also
206:necrosis
188:and the
184:via the
155:pancreas
111:duodenum
103:duodenal
99:pancreas
48:ICD-9-CM
2211:Stomach
1947:2403907
1912:3703174
1860:3163279
1820:7524375
1765:Surgery
1741:7247017
1646:Surgery
1479:1876989
1395:1436015
1340:4356182
1300:9785921
1231:3364335
1070:8278566
1021:5340451
902:4830358
733:1570590
593:Surgery
518:or the
498:History
459:amylase
416:pylorus
402:called
151:en bloc
123:stomach
115:jejunum
66:D016577
2928:Hernia
2492:Rectum
2031:
1996:
1988:
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688:
680:
611:
408:spleen
346:Trauma
239:, the
231:, the
157:, the
3010:UKELD
2959:Other
2697:Liver
1994:S2CID
1951:S2CID
1908:S2CID
1591:S2CID
1435:S2CID
1391:S2CID
1124:S2CID
977:S2CID
686:S2CID
550:over
479:Ileus
74:[
3005:PELD
3000:MELD
2807:MRCP
2781:ERCP
2029:PMID
1986:PMID
1943:PMID
1900:PMID
1865:PMID
1816:PMID
1781:PMID
1746:PMID
1697:PMID
1662:PMID
1626:PMID
1583:PMID
1520:PMID
1484:PMID
1427:PMID
1383:PMID
1345:PMID
1323:2016
1296:PMID
1263:PMID
1236:PMID
1189:2017
1159:PMID
1116:PMID
1075:PMID
1026:PMID
969:PMID
907:PMID
858:PMID
823:PMID
788:PMID
738:PMID
678:PMID
646:2017
609:PMID
542:and
60:MeSH
53:52.7
2812:PTC
2154:SGs
2050:at
2021:doi
2017:144
1978:doi
1935:doi
1892:doi
1855:PMC
1847:doi
1839:HPB
1808:doi
1804:168
1773:doi
1769:138
1736:PMC
1728:doi
1689:doi
1654:doi
1650:142
1618:doi
1614:143
1573:doi
1512:doi
1474:PMC
1466:doi
1462:245
1419:doi
1375:doi
1335:PMC
1327:doi
1226:PMC
1216:doi
1151:doi
1147:186
1106:doi
1065:PMC
1057:doi
1016:PMC
1008:doi
961:doi
897:PMC
889:doi
885:113
850:doi
815:doi
780:doi
728:PMC
720:doi
716:244
670:doi
601:doi
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