40:
145:
468:
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
429:, 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.
215:. 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
153:
496:
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
467:
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
432:
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
383:
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
365:
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,
455:
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
226:
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
302:, 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.
388:
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.
266:, 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
1419:
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".
333:, 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
417:. 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
180:
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.
374:
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,
444:
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
379:
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.
1654:
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)".
425:. 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
1512:
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".
353:. 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.
472:
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%).
670:
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".
456:
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.
39:
188:
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.
1152:
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".
1893:
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".
2119:
366:
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.
1774:
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".
1297:
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".
1326:"Pylorus-preserving pancreaticoduodenectomy (pp Whipple) versus pancreaticoduodenectomy (classic Whipple) for surgical treatment of periampullary and pancreatic carcinoma"
3020:
1465:"A systematic review and meta-analysis of pylorus-preserving versus classical pancreaticoduodenectomy for surgical treatment of periampullary and pancreatic carcinoma"
557:
are often used interchangeably in the medical literature, scrutinizing their etymology yields different definitions for the two terms. As a result, the authors prefer
318:
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.
2791:
962:
Tsuchikawa T, Hirano S, Okamura K, Matsumoto J, Tamoto E, Murakami S, et al. (March 2015). "Advances in the surgical treatment of hilar cholangiocarcinoma".
120:. 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
2752:
1846:"Moving towards the New International Study Group for Pancreatic Surgery (ISGPS) definitions in pancreaticoduodenectomy: a comparison between the old and new"
392:
Further contraindications include encasement of major vessels (such as celiac artery, inferior vena cava, or superior mesenteric artery) as mentioned above.
2817:
459:
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.
3056:
2087:
The
Toronto Video Atlas of Liver, Pancreas and Transplant Surgery Patient Education Module – Patient and Family Education video for the Whipple procedure
1548:
144:
2822:
2112:
602:
Fingerhut A, Vassiliu P, Dervenis C, Alexakis N, Leandros E (September 2007). "What is in a word: Pancreatoduodenectomy or pancreaticoduodenectomy?".
1809:
Cullen JJ, Sarr MG, Ilstrup DM (October 1994). "Pancreatic anastomotic leak after pancreaticoduodenectomy: incidence, significance, and management".
501:
is typically maintained to suction, to drain gastric and intestinal contents. Ambulation is encouraged to stimulate return of bowel function. Use of
2558:
1619:
Syin D, Woreta T, Chang DC, Cameron JL, Pronovost PJ, Makary MA (November 2007). "Publication bias in surgery: implications for informed consent".
2715:
254:. These structures are important to consider in this operation especially if done for resection of a tumor located in the head of the pancreas.
63:
1007:"Surgical strategies in the treatment of chronic pancreatitis: An updated systematic review and meta-analysis of randomized controlled trials"
2270:
2105:
298:
or locally advanced un-resectable disease; thus only 15–20% of patients are candidates for the
Whipple procedure. Surgery may follow
2319:
447:
204:
196:
481:
Immediately after surgery, patients are monitored for return of bowel function and appropriate closed-suction drainage of the abdomen.
2757:
2091:
538:
3015:
3010:
350:
765:
2548:
644:
2255:
2206:
279:
2229:
1105:"Trauma Whipple: do or don't after severe pancreaticoduodenal injuries? An analysis of the National Trauma Data Bank (NTDB)"
1187:
767:, Lillemoe K, Loehrer A. Whipple procedure for multiple endocrine neoplasia of the pancreas. J Med Ins. 2018;2018(16). doi:
2637:
2381:
1556:
2903:
2622:
2449:
2395:
2326:
2155:
2146:
851:
Wolff RA (February 2018). "Adjuvant or
Neoadjuvant Therapy in the Treatment in Pancreatic Malignancies: Where Are We?".
2191:
2812:
2647:
164:
removal of the distal segment (antrum) of the stomach, the first and second portions of the duodenum, the head of the
888:"Postoperative complications and overall survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma"
3066:
3061:
2720:
2642:
2510:
2369:
247:
200:
184:
At the very beginning of the procedure, after the surgeons have gained access to the abdomen, the surfaces of the
2908:
2698:
2612:
2520:
2439:
2211:
2201:
2086:
1376:
Michalski CW, Weitz J, BĂĽchler MW (September 2007). "Surgery insight: surgical management of pancreatic cancer".
578:
1979:
Vather R, Bissett I (May 2013). "Management of prolonged post-operative ileus: evidence-based recommendations".
238:
Relevant nearby anatomy not removed during the procedure include the major vascular structures in the area: the
3002:
2857:
2515:
2196:
2138:
299:
243:
70:
2951:
2492:
2250:
2097:
1570:
de Wilde RF, Besselink MG, van der Tweel I, de Hingh IH, van Eijck CH, Dejong CH, et al. (March 2012).
2981:
2796:
2260:
2129:
2081:
498:
362:
1690:
Traverso LW, Hashimoto Y (2008). "Delayed gastric emptying: the state of the highest level of evidence".
2956:
2886:
2742:
2336:
2297:
3025:
2022:
Schnelldorfer T, Sarr MG (December 2009). "Alessandro
Codivilla and the first pancreatoduodenectomy".
1103:
van der Wilden GM, Yeh D, Hwabejire JO, Klein EN, Fagenholz PJ, King DR, et al. (February 2014).
2553:
514:
409:, mostly because patients who submit to this operation tend to develop a particularly severe form of
406:
346:
267:
263:
208:
2077:
Toronto
Whipple Clinical Pathway Education App - Open access App for patient and caregiver education
886:
Pugalenthi A, Protic M, Gonen M, Kingham TP, Angelica MI, Dematteo RP, et al. (February 2016).
2928:
2852:
2747:
2652:
2627:
2543:
2538:
2482:
2277:
1324:
HĂĽttner FJ, Fitzmaurice C, Schwarzer G, Seiler CM, Antes G, BĂĽchler MW, Diener MK (February 2016).
569:
should refer to the resection of the duodenum and pancreatic duct rather than the pancreas itself.
1056:"Duodenum-preserving pancreatic resection versus pancreaticoduodenectomy for chronic pancreatitis"
2422:
2265:
2004:
1961:
1918:
1601:
1445:
1401:
1134:
987:
696:
326:
251:
1727:"Computed tomography evaluation of early post-operative complications of the Whipple procedure"
2988:
2872:
2834:
2680:
2590:
2412:
2304:
2245:
2082:
The Toronto Video Atlas of Liver, Pancreas and Transplant Surgery – Video of Whipple procedure
2039:
1996:
1953:
1910:
1875:
1826:
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1707:
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105:
58:
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518:
414:
271:
223:
169:
816:
O Kane GM, Knox JJ (2017-11-16). "Locally advanced pancreatic cancer: An emerging entity".
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taken in the immediate post-operative period to minimize prolonged post-operative ileus. A
3030:
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2786:
2781:
2568:
2464:
2454:
2429:
2417:
2404:
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829:
441:
Pancreaticoduodenectomy is considered, by any standard, to be a major surgical procedure.
228:
44:
The pancreas, stomach, and bowel are joined back together after a pancreaticoduodenectomy
2062:
3035:
2862:
2725:
2670:
2376:
2346:
2240:
2181:
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1870:
1845:
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1080:
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1031:
1006:
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887:
743:
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718:
522:
452:
1822:
1572:"Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality"
3050:
2946:
2675:
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2176:
1861:
1138:
534:
212:
192:
2008:
1965:
1605:
1463:
Diener MK, Knaebel HP, Heukaufer C, Antes G, BĂĽchler MW, Seiler CM (February 2007).
1449:
991:
700:
2923:
2737:
2632:
2617:
2472:
2094:– The original description of Whipple's operation together with a modern commentary
1922:
1405:
1341:
1071:
117:
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in New York and subsequently came up with multiple refinements to his technique.
76:
17:
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1104:
939:"Periampullary Cancer: Symptoms, Staging & Treatment | Dr. Nikhil Agrawal"
864:
794:
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275:
235:. This portion is not done en bloc, as the gallbladder is removed separately.
185:
177:
152:
2773:
2576:
2487:
2477:
2434:
2364:
2168:
405:
Clinical trials have failed to demonstrate significant survival benefits of
337:, or removal of part of the liver, with or without pancreaticoduodenectomy.
330:
262:
Pancreaticoduodenectomy is most often performed as a curative treatment for
2043:
2000:
1914:
1879:
1795:
1760:
1742:
1711:
1676:
1640:
1597:
1534:
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1441:
1397:
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1173:
1130:
1089:
1040:
983:
921:
872:
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802:
752:
692:
623:
27:
Major surgical procedure involving the pancreas, duodenum, and other organs
1957:
1830:
1310:
290:
Pancreaticoduodenectomy is the only potentially curative intervention for
161:
2844:
2585:
2092:"Whipple pancreaticoduodenectomy: a historical comment Adrian O'Sullivan"
216:
165:
121:
113:
109:
294:. However, the majority of patients with pancreatic cancer present with
86:
2221:
1949:
1389:
469:
426:
422:
160:
The most common technique of a pancreaticoduodenectomy consists of the
133:
125:
1992:
903:
2938:
2502:
1588:
1571:
502:
418:
768:
2707:
489:
151:
143:
53:
Pancreatoduodenectomy, Whipple procedure, Kausch-Whipple procedure
1936:
Livingston EH, Passaro EP (January 1990). "Postoperative ileus".
421:) is removed to prevent further spread of infection and possible
310:
Ampullary cancer arises from the lining of the ampulla of Vater.
537:
who devised an improved version of the surgery in 1935 while at
2101:
1054:
Gurusamy KS, Lusuku C, Halkias C, Davidson BR (February 2016).
104:, is a major surgical operation most often performed to remove
1213:
Zakharova, OP; Karmazanovsky, GG; Egorov, VI (27 May 2012).
2076:
645:"Surgical resection of lesions of the head of the pancreas"
781:
Clancy TE (August 2015). "Surgery for Pancreatic Cancer".
717:
Cameron JL, Riall TS, Coleman J, Belcher KA (July 2006).
525:
in 1909 and described by him in 1912. It is often called
517:, an Italian surgeon, in 1898. The first resection for a
278:
to the pancreas, multiple endocrine neoplasia type 1 and
207:. There are additional smaller branches given off by the
505:, which interfere with intestinal motility, is limited.
222:
While the blood supply to the liver is left intact, the
565:
for the name of this procedure, as strictly speaking
112:. It is also used for the treatment of pancreatic or
719:"One thousand consecutive pancreaticoduodenectomies"
3001:
2969:
2937:
2894:
2885:
2843:
2768:
2706:
2697:
2661:
2567:
2529:
2501:
2463:
2403:
2394:
2355:
2220:
2163:
2154:
2145:
1555:. Harvard Health Publications. 2009. Archived from
148:
The tissue removed during a pancreaticoduodenectomy
69:
57:
49:
32:
964:Expert Review of Gastroenterology & Hepatology
643:
349:typically includes pain control and management of
1215:"Pancreatic adenocarcinoma: Outstanding problems"
1371:
1369:
191:The vascular supply of the pancreas is from the
1272:. Treasure Island (FL): StatPearls Publishing.
2753:Transjugular intrahepatic portosystemic shunt
2113:
8:
1692:Journal of Hepato-Biliary-Pancreatic Surgery
783:Hematology/Oncology Clinics of North America
549:Fingerhut et al. argue that while the terms
492:, which refers to functional obstruction or
1330:The Cochrane Database of Systematic Reviews
1060:The Cochrane Database of Systematic Reviews
1005:Zhao X, Cui N, Wang X, Cui Y (March 2017).
597:
595:
593:
521:cancer was performed by the German surgeon
513:This procedure was originally described by
2891:
2703:
2400:
2160:
2151:
2120:
2106:
2098:
38:
1869:
1750:
1587:
1488:
1349:
1264:D'Cruz JR, Misra S, Shamsudeen S (2023).
1240:
1230:
1219:World Journal of Gastrointestinal Surgery
1120:
1079:
1030:
911:
742:
361:Damage to the pancreas and duodenum from
2559:Transanal hemorrhoidal dearterialization
2716:Artificial extracorporeal liver support
1844:Tan WJ, Kow AW, Liau KH (August 2011).
589:
401:Pylorus-sparing pancreaticoduodenectomy
384:separate procedure called a diagnostic
29:
1515:European Journal of Surgical Oncology
933:
931:
853:The Surgical Clinics of North America
830:10.1016/j.currproblcancer.2017.10.006
712:
710:
7:
2271:Vertical banded gastroplasty surgery
637:
635:
633:
539:Columbia-Presbyterian Medical Center
2320:Percutaneous endoscopic gastrostomy
2128:Tests and procedures involving the
1895:Journal of Gastrointestinal Surgery
448:The New England Journal of Medicine
205:inferior pancreaticoduodenal artery
197:superior pancreaticoduodenal artery
82:
2758:Distal splenorenal shunt procedure
1481:10.1097/01.sla.0000242711.74502.a9
1378:Nature Clinical Practice. Oncology
735:10.1097/01.sla.0000217673.04165.ea
25:
3057:Accessory digestive gland surgery
140:Anatomy involved in the procedure
132:, and, occasionally, part of the
1862:10.1111/j.1477-2574.2011.00336.x
1621:The Journal of Surgical Research
1553:Pri-Med Patient Education Center
1154:The Journal of Surgical Research
769:https://doi.org/10.24296/jomi/16
292:malignant tumors of the pancreas
2549:Lateral internal sphincterotomy
1938:Digestive Diseases and Sciences
280:gastrointestinal stromal tumors
211:which is also derived from the
2256:Endoscopic sleeve gastroplasty
2207:Functional Lumen Imaging Probe
1576:The British Journal of Surgery
1342:10.1002/14651858.CD006053.pub6
1072:10.1002/14651858.CD011521.pub2
1:
2638:Lower gastrointestinal series
2382:Upper gastrointestinal series
1823:10.1016/s0002-9610(05)80151-5
1725:Emekli E, GĂĽndoÄźdu E (2020).
533:, after the American surgeon
272:benign tumors of the pancreas
108:tumours from the head of the
2904:Diagnostic peritoneal lavage
2623:Double-contrast barium enema
2450:Partial ileal bypass surgery
2327:Esophagogastric dissociation
976:10.1586/17474124.2015.960393
892:Journal of Surgical Oncology
2721:Bioartificial liver devices
2648:Transrectal ultrasonography
1811:American Journal of Surgery
1731:Polish Journal of Radiology
1422:Annals of Surgical Oncology
1023:10.1097/MD.0000000000006220
642:Reber H (24 October 2016).
463:Postoperative complications
231:is performed to remove the
3083:
2643:Small-bowel follow-through
2511:Abdominoperineal resection
2370:Esophagogastroduodenoscopy
1788:10.1016/j.surg.2005.05.001
1669:10.1016/j.surg.2007.05.005
1527:10.1016/j.ejso.2007.12.004
1188:"Pancreatic Cancer Stages"
818:Current Problems in Cancer
616:10.1016/j.surg.2007.06.002
248:superior mesenteric artery
201:superior mesenteric artery
3003:Clinical prediction rules
2909:Intraperitoneal injection
2613:Abdominal ultrasonography
2521:Total mesorectal excision
2440:Intestine transplantation
2230:Sengstaken–Blakemore tube
2212:High resolution manometry
2202:Esophageal motility study
2136:
2036:10.1001/archsurg.2009.219
1907:10.1007/s11605-017-3622-8
1704:10.1007/s00534-007-1304-8
1633:10.1016/j.jss.2007.03.035
1434:10.1245/s10434-006-9330-3
1266:"Pancreaticoduodenectomy"
1194:. American Cancer Society
1166:10.1016/j.jss.2013.07.057
1122:10.1007/s00268-013-2257-5
865:10.1016/j.suc.2017.09.009
795:10.1016/j.hoc.2015.04.001
685:10.1007/s00268-014-2633-9
579:List of surgeries by type
83:
37:
2858:Pancreas transplantation
2516:Lower anterior resection
2197:Esophageal pH monitoring
2139:Digestive system surgery
1109:World Journal of Surgery
673:World Journal of Surgery
485:Return of bowel function
300:neoadjuvant chemotherapy
244:superior mesenteric vein
2952:Inguinal hernia surgery
2868:Pancreaticoduodenectomy
2251:Adjustable gastric band
2192:Impedance–pH monitoring
1549:"The Whipple Procedure"
567:pancreaticoduodenectomy
563:pancreaticoduodenectomy
555:pancreaticoduodenectomy
437:Morbidity and mortality
396:Surgical considerations
98:pancreaticoduodenectomy
33:Pancreaticoduodenectomy
2982:Exploratory laparotomy
2797:Hepatoportoenterostomy
2261:Gastric bypass surgery
2130:human digestive system
1981:ANZ Journal of Surgery
1743:10.5114/pjr.2020.93399
1232:10.4240/wjgs.v4.i5.104
477:Recovery after surgery
363:blunt abdominal trauma
351:exocrine insufficiency
157:
149:
2957:Femoral hernia repair
2743:Liver transplantation
2337:Nissen fundoplication
559:pancreatoduodenectomy
551:pancreatoduodenectomy
155:
147:
2554:Rubber band ligation
2493:Hartmann's operation
515:Alessandro Codivilla
407:total pancreatectomy
347:chronic pancreatitis
341:Chronic pancreatitis
268:chronic pancreatitis
264:periampullary cancer
209:right gastric artery
2929:Peritoneal dialysis
2748:Portal hypertension
2653:Virtual colonoscopy
2628:Endoanal ultrasound
2544:Anorectal manometry
2539:Anal sphincterotomy
2483:Colonic polypectomy
2278:Collis gastroplasty
2024:Archives of Surgery
527:Whipple's procedure
329:, or cancer of the
258:Medical indications
116:trauma, or chronic
2423:Jejunoileal bypass
2266:Sleeve gastrectomy
1950:10.1007/bf01537233
1390:10.1038/ncponc0925
503:opioid medications
327:Cholangiocarcinoma
322:Cholangiocarcinoma
252:inferior vena cava
158:
150:
100:, also known as a
3067:Surgical oncology
3062:Pancreatic cancer
3044:
3043:
2989:Rapid urease test
2965:
2964:
2881:
2880:
2873:Puestow procedure
2835:Cholescintigraphy
2693:
2692:
2689:
2688:
2681:Stool guaiac test
2591:Capsule endoscopy
2413:Bariatric surgery
2390:
2389:
2305:Gastroenterostomy
2246:Bariatric surgery
2030:(12): 1179–1184.
1993:10.1111/ans.12102
1521:(11): 1237–1245.
1469:Annals of Surgery
1299:Panminerva Medica
943:Dr.Nikhil Agrawal
904:10.1002/jso.24125
723:Annals of Surgery
679:(10): 2708–2715.
531:Whipple procedure
411:diabetes mellitus
377:vascular surgeons
370:Contraindications
286:Pancreatic cancer
102:Whipple procedure
94:
93:
18:Whipple procedure
16:(Redirected from
3074:
3026:Child–Pugh score
2993:Urea breath test
2892:
2853:Frey's procedure
2830:Cholecystography
2704:
2401:
2236:Nasogastric tube
2161:
2152:
2122:
2115:
2108:
2099:
2065:
2054:
2048:
2047:
2019:
2013:
2012:
1976:
1970:
1969:
1933:
1927:
1926:
1890:
1884:
1883:
1873:
1841:
1835:
1834:
1806:
1800:
1799:
1771:
1765:
1764:
1754:
1737:(1): e104–e109.
1722:
1716:
1715:
1687:
1681:
1680:
1651:
1645:
1644:
1616:
1610:
1609:
1591:
1589:10.1002/bjs.8664
1567:
1561:
1560:
1559:on 27 July 2011.
1545:
1539:
1538:
1509:
1503:
1502:
1492:
1460:
1454:
1453:
1428:(6): 1825–1834.
1416:
1410:
1409:
1373:
1364:
1363:
1353:
1321:
1315:
1314:
1294:
1288:
1287:
1285:
1284:
1261:
1255:
1254:
1244:
1234:
1210:
1204:
1203:
1201:
1199:
1184:
1178:
1177:
1149:
1143:
1142:
1124:
1100:
1094:
1093:
1083:
1051:
1045:
1044:
1034:
1002:
996:
995:
959:
953:
952:
950:
949:
935:
926:
925:
915:
883:
877:
876:
848:
842:
841:
813:
807:
806:
778:
772:
763:
757:
756:
746:
714:
705:
704:
667:
661:
660:
658:
656:
647:
639:
628:
627:
599:
499:nasogastric tube
451:found operative
415:brittle diabetes
306:Ampullary cancer
224:common bile duct
170:common bile duct
87:edit on Wikidata
79:
42:
30:
21:
3082:
3081:
3077:
3076:
3075:
3073:
3072:
3071:
3047:
3046:
3045:
3040:
3031:Ranson criteria
2997:
2961:
2933:
2877:
2839:
2808:Cholangiography
2804:Medical imaging
2787:Cholecystostomy
2782:Cholecystectomy
2764:
2685:
2657:
2569:Medical imaging
2563:
2525:
2497:
2459:
2455:Strictureplasty
2430:Bowel resection
2418:Duodenal switch
2386:
2357:Medical imaging
2351:
2216:
2147:Digestive tract
2141:
2132:
2126:
2073:
2068:
2055:
2051:
2021:
2020:
2016:
1978:
1977:
1973:
1935:
1934:
1930:
1892:
1891:
1887:
1843:
1842:
1838:
1808:
1807:
1803:
1773:
1772:
1768:
1724:
1723:
1719:
1689:
1688:
1684:
1653:
1652:
1648:
1618:
1617:
1613:
1569:
1568:
1564:
1547:
1546:
1542:
1511:
1510:
1506:
1462:
1461:
1457:
1418:
1417:
1413:
1375:
1374:
1367:
1336:(2): CD006053.
1323:
1322:
1318:
1296:
1295:
1291:
1282:
1280:
1263:
1262:
1258:
1212:
1211:
1207:
1197:
1195:
1186:
1185:
1181:
1151:
1150:
1146:
1102:
1101:
1097:
1066:(2): CD011521.
1053:
1052:
1048:
1004:
1003:
999:
961:
960:
956:
947:
945:
937:
936:
929:
885:
884:
880:
850:
849:
845:
815:
814:
810:
780:
779:
775:
764:
760:
716:
715:
708:
669:
668:
664:
654:
652:
641:
640:
631:
601:
600:
591:
587:
575:
547:
511:
487:
479:
465:
453:mortality rates
439:
403:
398:
372:
359:
343:
324:
316:
314:Duodenal cancer
308:
288:
260:
229:cholecystectomy
156:Whipple surgery
142:
90:
75:
45:
28:
23:
22:
15:
12:
11:
5:
3080:
3078:
3070:
3069:
3064:
3059:
3049:
3048:
3042:
3041:
3039:
3038:
3036:Milan criteria
3033:
3028:
3023:
3018:
3013:
3007:
3005:
2999:
2998:
2996:
2995:
2986:
2985:
2984:
2973:
2971:
2967:
2966:
2963:
2962:
2960:
2959:
2954:
2949:
2943:
2941:
2935:
2934:
2932:
2931:
2926:
2921:
2916:
2911:
2906:
2900:
2898:
2889:
2887:Abdominopelvic
2883:
2882:
2879:
2878:
2876:
2875:
2870:
2865:
2863:Pancreatectomy
2860:
2855:
2849:
2847:
2841:
2840:
2838:
2837:
2832:
2827:
2826:
2825:
2820:
2815:
2800:
2799:
2794:
2789:
2784:
2778:
2776:
2766:
2765:
2763:
2762:
2761:
2760:
2755:
2745:
2740:
2735:
2730:
2729:
2728:
2726:Liver dialysis
2723:
2712:
2710:
2701:
2695:
2694:
2691:
2690:
2687:
2686:
2684:
2683:
2678:
2673:
2671:Fecal fat test
2667:
2665:
2659:
2658:
2656:
2655:
2650:
2645:
2640:
2635:
2630:
2625:
2620:
2615:
2609:
2608:
2603:
2598:
2593:
2588:
2583:
2573:
2571:
2565:
2564:
2562:
2561:
2556:
2551:
2546:
2541:
2535:
2533:
2527:
2526:
2524:
2523:
2518:
2513:
2507:
2505:
2499:
2498:
2496:
2495:
2490:
2485:
2480:
2475:
2469:
2467:
2461:
2460:
2458:
2457:
2452:
2447:
2442:
2437:
2432:
2427:
2426:
2425:
2420:
2409:
2407:
2398:
2396:Lower GI tract
2392:
2391:
2388:
2387:
2385:
2384:
2379:
2377:Barium swallow
2374:
2373:
2372:
2361:
2359:
2353:
2352:
2350:
2349:
2347:Schilling test
2344:
2339:
2334:
2329:
2324:
2323:
2322:
2312:
2307:
2302:
2301:
2300:
2295:
2290:
2280:
2275:
2274:
2273:
2268:
2263:
2258:
2253:
2243:
2241:Gastric lavage
2238:
2233:
2226:
2224:
2218:
2217:
2215:
2214:
2209:
2204:
2199:
2194:
2189:
2184:
2182:Heller myotomy
2179:
2173:
2171:
2158:
2156:Upper GI tract
2149:
2143:
2142:
2137:
2134:
2133:
2127:
2125:
2124:
2117:
2110:
2102:
2096:
2095:
2089:
2084:
2079:
2072:
2071:External links
2069:
2067:
2066:
2049:
2014:
1987:(5): 319–324.
1971:
1944:(1): 121–132.
1928:
1901:(3): 508–515.
1885:
1856:(8): 566–572.
1836:
1817:(4): 295–298.
1801:
1766:
1717:
1698:(3): 262–269.
1682:
1663:(5): 761–768.
1646:
1611:
1582:(3): 404–410.
1562:
1540:
1504:
1475:(2): 187–200.
1455:
1411:
1384:(9): 526–535.
1365:
1316:
1305:(3): 219–222.
1289:
1256:
1205:
1179:
1144:
1115:(2): 335–340.
1095:
1046:
997:
970:(3): 369–374.
954:
927:
898:(2): 188–193.
878:
843:
808:
789:(4): 701–716.
773:
758:
706:
662:
629:
610:(3): 428–429.
588:
586:
583:
582:
581:
574:
571:
546:
543:
523:Walther Kausch
510:
507:
486:
483:
478:
475:
464:
461:
438:
435:
402:
399:
397:
394:
371:
368:
358:
355:
342:
339:
323:
320:
315:
312:
307:
304:
287:
284:
259:
256:
141:
138:
92:
91:
84:
81:
80:
73:
67:
66:
61:
55:
54:
51:
47:
46:
43:
35:
34:
26:
24:
14:
13:
10:
9:
6:
4:
3:
2:
3079:
3068:
3065:
3063:
3060:
3058:
3055:
3054:
3052:
3037:
3034:
3032:
3029:
3027:
3024:
3022:
3019:
3017:
3014:
3012:
3009:
3008:
3006:
3004:
3000:
2994:
2990:
2987:
2983:
2980:
2979:
2978:
2975:
2974:
2972:
2968:
2958:
2955:
2953:
2950:
2948:
2947:Hernia repair
2945:
2944:
2942:
2940:
2936:
2930:
2927:
2925:
2922:
2920:
2917:
2915:
2912:
2910:
2907:
2905:
2902:
2901:
2899:
2897:
2893:
2890:
2888:
2884:
2874:
2871:
2869:
2866:
2864:
2861:
2859:
2856:
2854:
2851:
2850:
2848:
2846:
2842:
2836:
2833:
2831:
2828:
2824:
2821:
2819:
2816:
2814:
2811:
2810:
2809:
2805:
2802:
2801:
2798:
2795:
2793:
2790:
2788:
2785:
2783:
2780:
2779:
2777:
2775:
2771:
2767:
2759:
2756:
2754:
2751:
2750:
2749:
2746:
2744:
2741:
2739:
2736:
2734:
2731:
2727:
2724:
2722:
2719:
2718:
2717:
2714:
2713:
2711:
2709:
2705:
2702:
2700:
2696:
2682:
2679:
2677:
2676:Fecal pH test
2674:
2672:
2669:
2668:
2666:
2664:
2660:
2654:
2651:
2649:
2646:
2644:
2641:
2639:
2636:
2634:
2631:
2629:
2626:
2624:
2621:
2619:
2616:
2614:
2611:
2610:
2607:
2606:Sigmoidoscopy
2604:
2602:
2599:
2597:
2594:
2592:
2589:
2587:
2584:
2582:
2578:
2575:
2574:
2572:
2570:
2566:
2560:
2557:
2555:
2552:
2550:
2547:
2545:
2542:
2540:
2537:
2536:
2534:
2532:
2528:
2522:
2519:
2517:
2514:
2512:
2509:
2508:
2506:
2504:
2500:
2494:
2491:
2489:
2486:
2484:
2481:
2479:
2476:
2474:
2471:
2470:
2468:
2466:
2462:
2456:
2453:
2451:
2448:
2446:
2443:
2441:
2438:
2436:
2433:
2431:
2428:
2424:
2421:
2419:
2416:
2415:
2414:
2411:
2410:
2408:
2406:
2402:
2399:
2397:
2393:
2383:
2380:
2378:
2375:
2371:
2368:
2367:
2366:
2363:
2362:
2360:
2358:
2354:
2348:
2345:
2343:
2342:Pyloromyotomy
2340:
2338:
2335:
2333:
2330:
2328:
2325:
2321:
2318:
2317:
2316:
2313:
2311:
2308:
2306:
2303:
2299:
2296:
2294:
2291:
2289:
2286:
2285:
2284:
2281:
2279:
2276:
2272:
2269:
2267:
2264:
2262:
2259:
2257:
2254:
2252:
2249:
2248:
2247:
2244:
2242:
2239:
2237:
2234:
2231:
2228:
2227:
2225:
2223:
2219:
2213:
2210:
2208:
2205:
2203:
2200:
2198:
2195:
2193:
2190:
2188:
2185:
2183:
2180:
2178:
2177:Esophagectomy
2175:
2174:
2172:
2170:
2166:
2162:
2159:
2157:
2153:
2150:
2148:
2144:
2140:
2135:
2131:
2123:
2118:
2116:
2111:
2109:
2104:
2103:
2100:
2093:
2090:
2088:
2085:
2083:
2080:
2078:
2075:
2074:
2070:
2064:
2063:Who Named It?
2060:
2059:
2053:
2050:
2045:
2041:
2037:
2033:
2029:
2025:
2018:
2015:
2010:
2006:
2002:
1998:
1994:
1990:
1986:
1982:
1975:
1972:
1967:
1963:
1959:
1955:
1951:
1947:
1943:
1939:
1932:
1929:
1924:
1920:
1916:
1912:
1908:
1904:
1900:
1896:
1889:
1886:
1881:
1877:
1872:
1867:
1863:
1859:
1855:
1851:
1847:
1840:
1837:
1832:
1828:
1824:
1820:
1816:
1812:
1805:
1802:
1797:
1793:
1789:
1785:
1781:
1777:
1770:
1767:
1762:
1758:
1753:
1748:
1744:
1740:
1736:
1732:
1728:
1721:
1718:
1713:
1709:
1705:
1701:
1697:
1693:
1686:
1683:
1678:
1674:
1670:
1666:
1662:
1658:
1650:
1647:
1642:
1638:
1634:
1630:
1626:
1622:
1615:
1612:
1607:
1603:
1599:
1595:
1590:
1585:
1581:
1577:
1573:
1566:
1563:
1558:
1554:
1550:
1544:
1541:
1536:
1532:
1528:
1524:
1520:
1516:
1508:
1505:
1500:
1496:
1491:
1486:
1482:
1478:
1474:
1470:
1466:
1459:
1456:
1451:
1447:
1443:
1439:
1435:
1431:
1427:
1423:
1415:
1412:
1407:
1403:
1399:
1395:
1391:
1387:
1383:
1379:
1372:
1370:
1366:
1361:
1357:
1352:
1347:
1343:
1339:
1335:
1331:
1327:
1320:
1317:
1312:
1308:
1304:
1300:
1293:
1290:
1279:
1275:
1271:
1267:
1260:
1257:
1252:
1248:
1243:
1238:
1233:
1228:
1225:(5): 104–13.
1224:
1220:
1216:
1209:
1206:
1193:
1189:
1183:
1180:
1175:
1171:
1167:
1163:
1159:
1155:
1148:
1145:
1140:
1136:
1132:
1128:
1123:
1118:
1114:
1110:
1106:
1099:
1096:
1091:
1087:
1082:
1077:
1073:
1069:
1065:
1061:
1057:
1050:
1047:
1042:
1038:
1033:
1028:
1024:
1020:
1016:
1012:
1008:
1001:
998:
993:
989:
985:
981:
977:
973:
969:
965:
958:
955:
944:
940:
934:
932:
928:
923:
919:
914:
909:
905:
901:
897:
893:
889:
882:
879:
874:
870:
866:
862:
859:(1): 95–111.
858:
854:
847:
844:
839:
835:
831:
827:
823:
819:
812:
809:
804:
800:
796:
792:
788:
784:
777:
774:
770:
766:
762:
759:
754:
750:
745:
740:
736:
732:
728:
724:
720:
713:
711:
707:
702:
698:
694:
690:
686:
682:
678:
674:
666:
663:
651:
646:
638:
636:
634:
630:
625:
621:
617:
613:
609:
605:
598:
596:
594:
590:
584:
580:
577:
576:
572:
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2924:Paracentesis
2867:
2738:Liver biopsy
2633:Enteroclysis
2618:Defecography
2473:Appendectomy
2056:
2052:
2027:
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1627:(1): 88–93.
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1557:the original
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1281:. Retrieved
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1196:. Retrieved
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118:pancreatitis
101:
97:
95:
2914:Laparoscopy
2770:Gallbladder
2733:Hepatectomy
2663:Stool tests
2601:Proctoscopy
2596:Enteroscopy
2581:Colonoscopy
2465:Large bowel
2445:Jejunostomy
2405:Small bowel
2332:Hill repair
2315:Gastrostomy
2293:Billroth II
2283:Gastrectomy
2187:Sialography
1782:(1): 8–13.
1198:13 December
386:laparoscopy
335:hepatectomy
240:portal vein
233:gallbladder
227:surgery, a
178:Lymph nodes
174:gallbladder
130:gallbladder
124:, proximal
50:Other names
3051:Categories
2977:Laparotomy
2919:Omentopexy
2896:Peritoneum
2531:Anal canal
2310:Gastropexy
2288:Billroth I
1283:2023-07-29
1270:StatPearls
1192:Cancer.org
1160:(1): 1–6.
948:2023-01-02
585:References
296:metastatic
276:metastatic
246:, and the
186:peritoneum
172:, and the
2774:bile duct
2699:Accessory
2577:Endoscopy
2488:Colostomy
2478:Colectomy
2435:Ileostomy
2365:Endoscopy
2298:Roux-en-Y
2169:Esophagus
2058:synd/3492
1139:206947730
423:morbidity
331:bile duct
274:, cancer
203:from the
106:cancerous
2845:Pancreas
2586:Anoscopy
2044:20026839
2009:28400301
2001:23418987
1966:27117157
1915:29119528
1880:21762300
1796:16003309
1761:32467744
1712:18535763
1677:17981197
1641:17950077
1606:11120876
1598:22237731
1535:18242943
1499:17245171
1450:23001824
1442:17342566
1398:17728711
1360:26905229
1278:32809582
1251:22655124
1174:24011528
1131:24121363
1090:26837472
1041:28248878
1011:Medicine
992:39664698
984:25256146
922:26678349
873:29191281
838:29153290
803:26226905
753:16794383
701:20402342
693:24912627
655:12 March
650:UpToDate
624:17723902
573:See also
217:necrosis
199:and the
195:via the
166:pancreas
122:duodenum
114:duodenal
110:pancreas
59:ICD-9-CM
2222:Stomach
1958:2403907
1923:3703174
1871:3163279
1831:7524375
1776:Surgery
1752:7247017
1657:Surgery
1490:1876989
1406:1436015
1351:4356182
1311:9785921
1242:3364335
1081:8278566
1032:5340451
913:4830358
744:1570590
604:Surgery
529:or the
509:History
470:amylase
427:pylorus
413:called
162:en bloc
134:stomach
126:jejunum
77:D016577
2939:Hernia
2503:Rectum
2042:
2007:
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419:spleen
357:Trauma
250:, the
242:, the
168:, the
3021:UKELD
2970:Other
2708:Liver
2005:S2CID
1962:S2CID
1919:S2CID
1602:S2CID
1446:S2CID
1402:S2CID
1135:S2CID
988:S2CID
697:S2CID
561:over
490:Ileus
85:[
3016:PELD
3011:MELD
2818:MRCP
2792:ERCP
2040:PMID
1997:PMID
1954:PMID
1911:PMID
1876:PMID
1827:PMID
1792:PMID
1757:PMID
1708:PMID
1673:PMID
1637:PMID
1594:PMID
1531:PMID
1495:PMID
1438:PMID
1394:PMID
1356:PMID
1334:2016
1307:PMID
1274:PMID
1247:PMID
1200:2017
1170:PMID
1127:PMID
1086:PMID
1037:PMID
980:PMID
918:PMID
869:PMID
834:PMID
799:PMID
749:PMID
689:PMID
657:2017
620:PMID
553:and
71:MeSH
64:52.7
2823:PTC
2165:SGs
2061:at
2032:doi
2028:144
1989:doi
1946:doi
1903:doi
1866:PMC
1858:doi
1850:HPB
1819:doi
1815:168
1784:doi
1780:138
1747:PMC
1739:doi
1700:doi
1665:doi
1661:142
1629:doi
1625:143
1584:doi
1523:doi
1485:PMC
1477:doi
1473:245
1430:doi
1386:doi
1346:PMC
1338:doi
1237:PMC
1227:doi
1162:doi
1158:186
1117:doi
1076:PMC
1068:doi
1027:PMC
1019:doi
972:doi
908:PMC
900:doi
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861:doi
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791:doi
739:PMC
731:doi
727:244
681:doi
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