All operations

Whipple Procedure

• LEOPARD-2 Trial → 0% 9d mortality w/open vs 15% w/laparoscopic.
• Explore for mets (send frozens PRN), take down hepatic flexure, & perform Kocher (test clamp GDA).
• Open lesser sac then 270° dissection of SMV & SMA above 1st jejunal br.
• Create tunnel then resect panc head, duo (incisura to 3rd br of R gastroepiploic → 15cm past LoT), & CBD (send margins for frozen).
• Pass jejunum through mesentery to pt right of the middle colic artery.
• End-to-side PJ (Blumgart → stitch post-duo, through panc, ant duo; 1 superior to PD & 2 inferior). Antecolic if pylorus-sparing to ↓delayed gastric emptying.
• End-to-side choledochojejunostomy & cholecystectomy.
• End-to-side GJ.

Educational aid only. Verify every dose, indication, and guideline against current institutional protocol. This is not a substitute for clinical judgment.