DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Pancreatic cancer.
POSTOPERATIVE DIAGNOSIS: Pancreatic cancer.
OPERATION PERFORMED: Whipple surgery.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
ESTIMATED BLOOD LOSS: About 350 mL.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: After informed consent, the patient was brought to the operating room and placed on the operating table in supine position. General endotracheal anesthesia was induced. The patient was prepped and draped in sterile fashion. A generous midline incision was made from C5 to below the umbilicus. Subcutaneous tissue was divided with the help of Bovie cautery. Peritoneum was entered. A Thompson retractor was placed. Chest wall was retracted upwards. A Kocher maneuver was performed after evaluating for metastatic lesions. No metastatic lesions were found anywhere in the peritoneal cavity. Frozen section was sent from the omental lymph node, which was negative. A couple of other lymph nodes from porta vein were sent, and all frozen were negative.
The duodenum was completely mobilized with the Kocher maneuver down to the ligament of Treitz. Colon was separated by dividing gastrocolic ligament and all the attachments. Short gastric vessels were divided. The vessels at the pylorus of the stomach were divided. At this point, middle colic vein was traced onto the superior mesenteric vein and to the portal vein. Dissection was done behind neck of the pancreas with the help of a Kelly clamp, which was very easy without any difficulty.
At this point, stomach was divided with GIA 75 on a green load and pylorus was retracted to the right side and rest of the stomach to the left side. Gallbladder was taken down with the help of the Bovie cautery. Cystic duct was clipped and divided. Gallbladder was removed. Common bile duct was dissected about 2 cm below the junction of the hepatic ducts. Common bile duct was dilated up to 1 cm in size. Hepatic artery was dissected up to the junction of gastroduodenal artery and hepatic artery. Gastroduodenal artery was ligated with 2-0 silk and suture ligated with 2-0 Prolene. It was retracted to the left side.
Portal vein was dissected. A complete tunnel was made under the pancreas, and a Penrose drain was placed behind the pancreas on top of portal vein. At this point, small bowel was divided approximately 20 cm from ligament of Treitz. Mesenteric attachments were divided with the help of LigaSure device. The jejunum was reflected to the right side of the ligament of Treitz. There were large vessels from the superior mesenteric vein to the head of the pancreas. Inferior pancreaticoduodenal vein was ligated with 2-0 silk. Several of the large branches were ligated. The pancreas was separated from the retroperitoneum with the help of LigaSure device, and the specimen was removed. Before removing the specimen, frozen section was sent from the pancreatic margin, which was negative.
After removing the specimen, irrigation was done and the staple part of the jejunum was oversewn with the help of 3-0 silk. It was brought up in a retrocolic fashion. Pancreaticojejunostomy was done in two layers, mucosa-to-mucosa, with 3-0 PDS and 5-0 PDS. Choledochojejunostomy was done with 5-0 PDS in a running fashion. Gastrojejunostomy was done in a handsewn method in a canal fashion with 3-0 silk and 3-0 PDS. Irrigation was done. Two JP drains were left; one was behind the gastrojejunostomy in front of pancreatic jejunostomy. One was left behind the choledochojejunostomy. The fascia was closed with loop PDS. Skin was closed with staples. Dressing was applied. The patient was extubated and taken to recovery in stable fashion. I was present for the entire procedure and all the counts were correct.
