1. By Preston Paynter and Brielle Bowyer

2. Reasons for Procedure  Pancreatic Cancer  Chronic Pancreatitis  Severe trauma to the Pancreas

3. Diagnostic Procedures  CT scan  Needle biopsy  Cholangiopancreatography  Endoscopic ultrasound  Palpation of the pancreas

4. Procedure Summary  Resection Part or all of the pancreas, duodenum, gallbladder, distal stomach and surrounding lymph nodes are identified and removed.  Reconstruction Attachment of left over stomach, left over pancreas, and common bile duct to the jejunum. ** Class II wound unless spillage occurs.

5. Supplies and Instrumentation  Supplies Prep set Basic pack Basin set Blades ○ #10 ○ #11 Laparotomy drapes Bovie Suture ○ Doctors Pref. Dressing ○ Doctors Pref. Hemostatic agents Suction Head lamp  Instrumentation Major instrument set Vascular instruments Biliary instruments (in room) Long instruments Bowl resection set Retractors ○ Hand held ○ Self Retaining Ligating clip appliers and clips Staplers Drains

6. Operative Prep  Anesthesia General  Positioning Supine with arms on arm boards  Skin Prep Shave Begin where incision will be. Extends from chest to upper thighs and down to the table on both sides  Draping Lap sheet outlined with towels  Incision Left Sub-costal or upper midline **Special consideration -Lubricate and protect the patient’s eyes

7. Operative Procedure Resection  Incision is made  Exploration of the abdomen and assessment of the extent and resectability of the tumor is made.  Cholecystectomy  Removal of Lymph nodes in the surrounding area  Partial Gastrectomy  Vagotomy  Division of the Pancreas  Dissection of the retro-pancreatic vessels  Removal of Duodenum

8. Operative Procedure Reconstruction  Pancreaticojejunostomy  Hepaticojejunostomy  End-to-side gastrojejunostomy  NG tube placed  Drains placed behind the pacreatic and biliary anastomoses Stab wound made on the right side of the abdomen where drain tube exits. Secured at the skin level with 3-0 silk  Counts take place 4 total Counts  Abdomen closed

9. Post-Op  Immediate Postoperative Care Transport to PACU  Possible Complications Hemorrhage Wound Infection Fistula formation Recurrence of Pathology Leakage of Anastomosis Nutritional/Digestive concerns Ileus  Prognosis Depends on response to primary condition Mortality rate is 5% when surgery is performed by an experienced surgeon.