Case Reports in Surgery and Invasive Procedures

All submissions of the EM system will be redirected to Online Manuscript Submission System. Authors are requested to submit articles directly to Online Manuscript Submission System of respective journal.
Reach Us +1 (202) 780-3397

Commentary - Case Reports in Surgery and Invasive Procedures (2022) Volume 6, Issue 2

Endoscopic treatment of biliopancreatic pathology in patients with previous Whipple's Duodenopancreatectomy.

Zhan Ting *

Department of Surgery, York University, Toronto, Ontario, Canada

*Corresponding Author:
Zhan Ting
Department of Surgery,
York University, Toronto
Ontario, Canada

Received: 16-Feb-2022, Manuscript No. AACRSIP-22-106; Editor assigned: 18-Feb-2022, PreQC No. AACRSIP-22-106(PQ); Reviewed: 04-Mar-2022, QC No. AACRSIP-22-106; Revised: 07-Mar-2022, Manuscript No. AACRSIP-22-106(R); Published: 14-Mar-2022, DOI:10.35841/ aacrsip-6.2.106

Citation: Ting Z. Endoscopic treatment of biliopancreatic pathology in patients with previous Whipple's Duodenopancreatectomy. Case Rep Surg Invasive Proced. 2022;6(2):106

Visit for more related articles at Case Reports in Surgery and Invasive Procedures


A pancreaticoduodenectomy, otherwise called a Whipple technique, is a significant careful activity most frequently performed to eliminate dangerous growths from the top of the pancreas. It is additionally utilized for the therapy of pancreatic or duodenal injury, or ongoing pancreatitis. Because of the common blood supply of organs in the proximal gastrointestinal framework, careful expulsion of the top of the pancreas additionally requires evacuation of the duodenum, proximal jejunum, gallbladder, and, at times, part of the stomach


Whipple's duodenopancreatectomy, Biliopancreatic pathology.


Whipple life structures

The Whipple technique, otherwise called pancreaticoduodenectomy, was initially portrayed by Codivilla in 1898. In 1935, Whipple announced a better form of the medical procedure and along these lines fostered various refinements to his method. Normally used to treat disease or precancerous sores at the top of the pancreas, normal bile pipe (CBD), ampulla of Vater, or duodenum close to the pancreas, the Whipple system comprises of distal gastrectomy and expulsion of the pancreatic head, duodenum, proximal jejunum, CBD, and gallbladder. Reproduction comprises of appending the pancreas to the jejunum (pancreaticojejunostomy (PJ)), the normal hepatic conduit to the jejunum (choledochojejunostomy), and the stomach to the jejunum (gastrojejunostomy). The afferent appendage alludes to the piece of the jejunum between the gastrojejunostomy and PJ locales, and is typically 40 to 60 cm long [1].

As in different sorts of SAA, performing endoscopic assessment of the pancreatobiliary framework in post-Whipple patients is testing. Similar issues emerge, including the recognizable proof and intubation of the afferent appendage and achieving admittance to the choledochojejunostomy or PJ. Accomplishment of these objectives might be restricted by appendage angulation and attachments. An extra test includes recognizable proof of the choledochojejunostomy or PJ followed by cannulation [2].

Diagnostic eus in surgically altered anatomy

Like standard EUS assessment, a spiral or straight echoendoscope is utilized for indicative EUS. A forward-review (FV) echoendoscope might be especially helpful for performing EUS in patients with SAA. A FV echoendoscope is adjusted from the direct echoendoscope by changing the arrangement of the tip to consolidate a restricted straight EUS view with a norm forward endoscopic view that permits simpler headway through the gastrointestinal (GI) plot contrasted with conventional diagonal review echoendoscopes. Fine-needle goal (FNA) or fine-needle biopsy (FNB) might be performed through the FV echoendoscope as with a straight echoendoscope. Different gadgets might be progressed through the functioning divert in a straight course. The FV echoendoscope might be especially helpful in patients who have gone through the Billroth II method, while being of almost no advantage in the steadily difficult RYGB life structures inferable from the extremely significant distance that should be crossed to arrive at the ampulla [3].

Pancreaticoduodenectomy (PD) examples present a test for careful pathologists as a result of the general uncommonness of these examples, joined with the anatomic intricacy. Here, we depict our experience on the direction, analyzation, and inspecting of PD examples for a more down to earth and precise assessment of pancreatic, distal normal bile channel (CBD), and ampullary growths. For direction of PDs, ID of the "trapezoid," made by the vascular bed at the middle, the pancreatic neck edge on the left, and the uncinate edge on the right, is of outmost significance in observing every one of the appropriate edges of the example including the CBD, which is situated at the upper right edge of this trapezoid. After direction, every one of the edges can be tested. We present the uncinate edge completely as an opposite inked edge since this fat tissue-rich region frequently uncovers inconspicuous satellite carcinomas that are horribly imperceptible, and, with this methodology, the quantity of R1 resections has multiplied as far as we can tell. Then, at that point, to guarantee legitimate distinguishing proof of all lymph hubs (LNs), we use the orange-stripping approach, in which the delicate tissue encompassing the pancreatic head is shaved off in 7 for arbitrary reasons characterized areas, which likewise fill in as shaved examples of the alleged "peripancreatic delicate tissue" that characterizes pT3 in this American Joint Committee on Cancer TNM. With this methodology, our LN count expanded from 6 to 14 and LN inspiration rate from half to 73%.

Furthermore, in 90% of pancreatic ductal adenocarcinomas there are horribly undetected microfoci of carcinoma. For assurance of the essential site and the degree of the cancer, we think bisectioning of the pancreatic head, rather than hub (cross over) cutting, is the most noteworthy methodology. Furthermore, documentation of the discoveries in the duodenal surface of the ampulla is essential for ampullary carcinomas and their new site-explicit classification into 4 classes [4].

Consequently, we test both the CBD and the pancreatic channel from distal to the ampulla and slice the pancreatic head to the ampulla at a plane that goes through the two pipes. Then, at that point, we test the divided pancreatic head contingent upon the discoveries of the case. For instance, for appropriate arranging of ampullary carcinomas, it is basic to take the segments opposite to the duodenal serosa at the "groove" region, as ampullary carcinomas frequently stretch out to this area. Amputative (pivotal) segment of the ampulla, albeit great for documentation of the peri-Oddi spread of the intra-ampullary cancers, sadly refuses documentation of mucosal spread of the papilla of Vater growths (those emerging from the edge of the ampulla, where the pipes progress to duodenal mucosa and reaching out) into the adjoining duodenum. Pivotal separating additionally frequently neglects to record cancer spread to the "groove" region. Taking everything into account, information on the gross qualities of the anatomic trademarks is fundamental for appropriate analyzation of PD examples. Pancreatic ductal adenocarcinoma (red), ampullary carcinoma (blue), and distal normal bile conduit carcinoma (green) all emerge inside nearness to each other and can thusly cover as far as the anatomic space they involve. Moreover, pancreatic ductal adenocarcinoma can optionally include the ampulla or normal bile conduit, and ampullary carcinoma and distal normal bile channel carcinoma can also attack structures from which they didn't begin. Cautious thought of the size, focal point, show, and histology of every injury ought to take into account precise finding [5].


  1. Chen K, Pan Y, Liu XL, et al.Minimally invasive pancreaticoduodenectomy for periampullary disease: a comprehensive review of literature and meta-analysis of outcomes compared with open surgery. BMC Gastroenterol. 2017;17(1):120.
  2. Indexed at, Google Scholar, Cross Ref

  3. Zhang H, Lan X, Peng B, et al. Is total laparoscopic pancreaticoduodenectomy superior to open procedure? A meta-analysis. World J Gastroenterol. 2019;25(37):5711-731.
  4. Indexed at, Google Scholar, Cross Ref

  5. Yang Y, Fu X, Zhu S, et al. Vater's ampullary carcinoma increases the risk of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy: A retrospective and propensity score-matched analysis. BMC Gastroenterol. 2022;22(1):51.
  6. Indexed at, Google Scholar, Cross Ref

  7. Gagner M, Palermo M. Laparoscopic whipple procedure: review of the literature. J Hepatobiliary Pancreat Surg. 2009;16(6):726-30.
  8. Indexed at, Google Scholar, Cross Ref

  9. Karamanolis G, Tack J.Nutrition and motility disorders. Best Pract Res Clin Gastroenterol. 2006;20(3):485-505.
  10. Indexed at, Google Scholar, Cross Ref

Get the App