Cephalic duodenopancreatectomy, also known as the Whipple procedure, is a highly intricate and invasive surgical procedure in the field of digestive surgery. The operation involves the removal of the gallbladder, the distal third of the stomach, bile ducts, the duodenum, and the head of the pancreas. A crucial part of the procedure involves the removal of lymph nodes situated around major blood vessels that must be preserved. This enables the resection of the primary tumour and the surrounding tissue that may contain metastases in the lymphatic channels, glands, and around the nerve plexuses. The excision of the mesopancreas, which involves the complete removal of the tissue containing the lymphatic channels and nerves situated behind the head of the pancreas, is becoming increasingly popular worldwide. This is because it has been noted that malignant cells are present in this tissue, which can be a cause of disease recurrence.
Cephalic duodenopancreatectomy is typically recommended for the surgical treatment of tumours located in the region of the head of the pancreas, and less frequently, for chronic pancreatitis. It is rarely indicated for pancreatic or duodenal injuries.
Cephalic duodenopancreatectomy is a technically challenging operation that carries the risk of postoperative complications. Complications specific to this procedure include pancreatic fistula, bleeding, and delayed gastric emptying. Pancreatic fistula refers to the leakage of pancreatic juice due to poor healing of the surgical connection between the remaining pancreas and the intestine. Bleeding after surgery is typically a result of previous complications. Delayed gastric emptying is characterized by nausea, vomiting, and difficulty in taking food orally.
Following the procedure, the patient usually spends a day in the intensive care unit. They receive assistance to get up on the first day and can walk independently from the second or third day. Liquid food intake begins on the second or third day after surgery. If there are no complications, the average hospital stay is around seven days.
