Whipples Procedure Figure 36 Initial Procedure

• open with scissors by cutting along the lesser curvature of the stomach and the free border of the duodenum.

• measurements:

- lengths (cm) of distal sleeve of stomach and duodenum, and parts present (D1-4).

- dimensions (cm) of pancreas, and parts present (head, body).

- lengths of gall bladder and bile duct (cm).

• fixation by immersion in 10% formalin for 24-36 hours.

• sample the following surgical margins: proximal gastric, distal duodenal, distal pancreatic face to include the pancreatic duct, and proximal common bile duct.

• paint the external anatomical and surgical margins using different colours of ink and label appropriately - superior, inferior, anterior capsule, posterior retroperitoneal, medial (superior mesenteric vein).

• carefully insert a fine probe into the distal end of the pancreatic duct and gently advance, if possible, to the ampulla.

• place the specimen flat on the bench and with a long, sharp knife use the probe as a guide to horizontally hemisect it, cutting through the peripancreatic duodenum and pancreas. Alternatively, a vertical coronal slice may be used.

• further 24 hours fixation may be required.

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