From the Guidelines
Yes, the gastroduodenal artery (GDA) is typically divided during a Whipple procedure. This major surgical procedure involves removing the head of the pancreas, the duodenum, a portion of the bile duct, the gallbladder, and sometimes part of the stomach. The GDA must be identified, ligated, and divided during the operation because it supplies blood to portions of the anatomy being removed, particularly the duodenum and the head of the pancreas.
Key Considerations
- Careful management of the GDA is critical during a Whipple procedure to prevent potentially life-threatening hemorrhage, as this artery is a major branch of the common hepatic artery.
- Surgeons typically identify the GDA early in the dissection phase, carefully isolate it, and then divide it between ligatures or using vascular stapling devices to ensure proper hemostasis.
- This step is considered standard practice in performing a safe and complete Whipple procedure, as outlined in guidelines such as those from the National Comprehensive Cancer Network (NCCN) 1.
Surgical Approach
- The nature and extent of the surgery for resectable tumors depend on the location and size of the tumor, with the Whipple procedure being a common approach for tumors in the head of the pancreas.
- The procedure may involve an open or minimally invasive approach, with the goal of removing the tumor and affected tissues while preserving as much normal tissue and function as possible.
- The decision to divide the GDA is based on the need to remove the affected tissues and ensure proper hemostasis, rather than on the potential for extended regional lymphadenectomy, which has not been shown to provide a survival advantage in several randomized controlled trials (RCTs) 1.
From the Research
Gastroduodenal Artery (GDA) Management During Whipple Procedure
- The GDA is a critical artery that supplies blood to the stomach and duodenum, and its management is crucial during a Whipple procedure 2, 3.
- In some cases, the GDA may be ligated or resected during a Whipple procedure to control bleeding or remove a tumor 4, 5.
- However, ligation or resection of the GDA can lead to complications, such as hemorrhage or ischemia, and requires careful consideration and planning 2, 6.
Complications Associated with GDA Management
- Hemorrhagic complications can occur after Whipple surgery, and the GDA is a common site of bleeding 2.
- The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) has been reported as a potentially lifesaving measure in cases of massive abdominal or pelvic hemorrhage, including bleeding from the GDA 3.
- Major vascular reconstruction during a Whipple procedure, including reconstruction of the GDA, can lead to decreased survival and increased morbidity compared to conventional Whipple procedures 6.
Surgical Techniques for GDA Management
- The "Whipple at the Splenic Artery (WATSA)" procedure is a surgical technique that involves resecting tumors of the neck of the pancreas with venous invasion, and may require ligation or resection of the GDA 5.
- Ulcer oversewing and artery ligation, including ligation of the GDA, can be used to control bleeding in patients with gastroduodenal hemorrhage 4.