Pancreatic head and duodenectomy, also known as Whipple surgery, is a common surgical procedure for the treatment of pancreatic head and peripancreatic cancer, and is the most complex surgery in general surgery. The pancreas is a strip-shaped glandular organ, about 12-20 cm long and 3-5 cm wide in adults, weighing about 70-120 g. It is located in the upper abdomen, directly behind the stomach and above the small intestine. The small intestine is divided into three parts: duodenum, jejunum and ileum, and the pancreas is also divided into three parts: head, body and tail. The head of the pancreas is surrounded by the duodenum, the body of the pancreas is located behind the stomach, and the tail of the pancreas is located near the splenic hilum. A part of the lower edge of the head of the pancreas is wrapped around the superior mesenteric vessels, called the leptomen. The pancreatic duct is located in the parenchyma of the pancreas, through which digestive enzymes are discharged into the duodenum. The opening of the pancreatic duct in the duodenum is called the Vater’s jugular. If the tumor is located in the head of the pancreas or the jugular abdomen, the bile can be blocked from draining into the duodenum, and the patient can develop jaundice and itchy skin. The main function of the pancreas is to secrete various hormones and digestive enzymes, which is known as endocrine and exocrine functions. The main hormones include insulin and glucagon (both of which affect blood sugar levels), and the main function of digestive enzymes is to assist in the digestion of food, mainly fat. Although pancreatic surgery removes a portion of pancreatic tissue, the above functions of the pancreas can usually be preserved and in a few cases elevated blood glucose will occur. If the remaining pancreas is not sufficient to produce the digestive enzymes needed for digestion, oral medication (pancreatic enzymes) must be taken as a replacement therapy, usually before meals. Pre-surgery preparation Proper aerobic exercise daily, which is beneficial for post-operative recovery; Strict smoking cessation; Blood tests, including blood, urine, stool routine, biochemistry complete, electrolytes, coagulation, hepatitis B, hepatitis C, HIV, syphilis antibodies, tumor markers, etc.; Chest X-ray, ECG, abdominal CT, MRI; If other systemic diseases, such as heart and lung organs, are present, relevant tests are required; Enema one day before surgery or oral laxatives to cleanse the intestines; a light diet the day before surgery, and water abstinence from the early morning of the day of surgery; appropriate fluids and intravenous antibiotics to prevent infection before surgery; and an indwelling gastric tube and urinary catheter on the morning of surgery. Surgical method The resection includes the head of the pancreas (including the hooks), the distal stomach, duodenum, upper jejunum, gallbladder and common bile duct, as well as the removal of the surrounding associated lymph nodes, and finally the reconstruction of the distal pancreas, the severed end of the bile duct and the remnant stomach and jejunum. After surgery, the patient is usually observed in the surgical intensive care unit for one day and then transferred back to the general ward; the gastric tube is inserted into the stomach through the nostrils, mainly to drain the digestive juices in the stomach and prevent vomiting. A T-tube is placed in the common bile duct to drain the bile and is protected from dislodgement during movement. A pain pump will be connected through an intravenous or epidural catheter, allowing patients to administer their own pain medication, which can be used appropriately to relieve pain during walking, coughing and deep breathing. Early movement to the floor, which can be started on the 2nd-3rd postoperative day is generally recommended to improve blood circulation, prevent thrombosis and promote recovery of gastrointestinal function; Patients will be asked to initiate coughing and deep breathing exercises, as well as the use of nebulized inhalation devices to prevent pulmonary atelectasis and lung infection; Wounds are usually changed on the 3rd postoperative day, so please inform your healthcare provider if there is any abnormal bleeding and exudation; Early postoperative period requires the use of trans treatment with intravenous fluid supplementation, parenteral nutrition solution, acid-suppressing drugs, antibiotics, etc.; transoral feeding can usually be started after removal of the gastric tube, starting with water initially, then gradually changing to liquid, semi-liquid, until regular diet; if there is no significant appetite at first, enteral nutrition solution can be given under medical advice; some patients may develop fat indigestion after surgery, and steatorrhea may occur after eating fat-containing food. A small number of patients have a mild fever (temperature between 37-38 degrees Celsius), which usually resolves within 3-5 days; most patients experience weight loss before surgery and during the recovery period. Most patients will experience weight loss before surgery and during the recovery period, which will not resolve for some time, but should seek to gain weight after discharge. symptoms of discomfort. Discharge When normal diet is resumed, normal intestinal function, no comorbidities appear, and no obvious discomfort can be considered for discharge. Before discharge, the doctor will give you discharge advice, prescribe the medication to be taken after discharge, and the nurse will check the medication with you. The most common discomfort symptoms after surgery are loss of appetite, abdominal distension and easy satiety, which will improve with time. The fat intake should be limited, especially not too much animal fat at one time, avoid too much cold food, and not too much exercise after meals; another common discomfort symptom is easy fatigue 6-8 weeks after surgery, partly due to surgery and partly due to weight loss before surgery, which will improve with time and can be improved by gradually increasing the intensity of activities; during recuperation at home During the recuperation period at home, you may still feel pain in the wound, you can take pain medication if needed, but one of the side effects of pain medication is to cause constipation, you should drink more water and eat coarse fiber food to prevent it; physical exercise can help to regain strength and improve symptoms, walking is the best method, please consult your doctor before doing other more strenuous exercises, do not overdo it when exercising, have a regular life, ensure sufficient rest and sleep; the first 6 weeks after surgery It is not suitable to lift heavy objects over 5 kg. You can drive 1 month after surgery, but driving is not recommended after taking pain medication. Diet after pancreaticoduodenectomy For at least 15 days after surgery, patients should avoid fried foods (French fries, fried meat, etc.), sweets (cakes, chocolate, cream, etc.), high cholesterol foods (eggs, liver and shrimp, etc.), after which they can gradually return to their previous diet, but it is recommended that patients should focus on soft foods in their daily diet, reduce the intake of calories and fine carbohydrates, and reduce fat and Cholesterol intake should be accompanied by more dietary fiber. Food groups Allowed Prohibited/reduced Staple foods Fine rice and noodles Coarse grains, puffed and fried staples Dairy products Skimmed or low-fat milk or yogurt Whole milk or chocolate milk Eggs Egg whites, up to 1 per day Egg yolks, fried eggs Beverages Clear water, light tea Alcoholic beverages, coffee, strong tea Meat Skinless poultry, fish and lean meat (pork, beef, sheep, etc., cut off fat) Fatty meat, animal offal, fish roe, crab yolk, shrimp heads, bacon, salted meat, and crab meat. Shrimp heads, bacon, salted meat, canned meat, etc. Vegetables Low-fiber vegetables, such as peeled winter squash, potatoes, eggplant, cucumbers, tomatoes, etc. High-fiber vegetables, such as leeks, celery, beans, etc. Fruits Medium or low-sugar fruits (such as watermelon, apples, kiwi, strawberries, etc.), purees and fruit juices High-sugar fruits (such as lychees, grapes, sweet oranges, sugar cane, bananas, etc.) Sweets Light honey water, lotus root powder Excess cane sugar, sweets, chocolate Vegetable oils such as peanut oil, olive oil, soybean oil, tea oil, etc., total 10-15 g per day Animal oils, margarine and various trans fatty acid foods Other ketchup, garlic, vinegar, unbuttered popcorn Olives, peppers, cream and other fatty foods (e.g. cake) Cooking methods Steaming, stewing, etc. Frying, deep-frying, etc. Outpatient review We recommend that your first review be 2 weeks to 1 month after surgery. Your doctor will recommend blood tests, abdominal ultrasound, etc. depending on your actual condition.