The Whipple procedure (pancreaticoduodenectomy) involves resection of the pancreatic head, duodenum, proximal jejunum, gallbladder, and common bile duct. Which reconstruction is performed to re-establish pancreatic exocrine drainage?

• A Pancreatogastrostomy is the only accepted reconstruction
• B The pancreatic duct is ligated without anastomosis to prevent fistula
• C Roux-en-Y pancreatojejunostomy with a 70 cm biliopancreatic limb is mandatory
• D Pancreaticojejunostomy (duct-to-mucosa or invagination technique) is the standard; pancreatogastrostomy is an alternative with equivalent outcomes in some series ✓

Explanation

In the Whipple procedure, reconstitution of GI continuity involves three anastomoses: pancreaticojejunostomy (for exocrine drainage), hepaticojejunostomy (for bile drainage), and gastrojejunostomy (for gastric emptying). Pancreaticojejunostomy (duct-to-mucosa or invagination/dunking technique) is the most commonly performed and is considered the standard; pancreatogastrostomy has been proposed as an alternative with comparable postoperative pancreatic fistula rates in randomised trials. Neither ductal ligation alone nor a 70 cm limb is mandatory. The choice depends on surgeon preference and pancreatic remnant texture.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.