By Preston Paynter and Brielle Bowyer

 Pancreatic Cancer
 Chronic Pancreatitis
 Severe trauma to the Pancreas

 CT scan
 Needle biopsy
 Cholangiopancreatography
 Endoscopic ultrasound
 Palpation of the pancreas

 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.
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Class II wound unless spillage occurs.

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

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Anesthesia
 General
Positioning
 Supine with arms on arm boards
Skin Prep
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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
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Lubricate and protect the patient’s eyes

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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

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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

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