From the Guidelines
The gastroduodenal artery (GDA) is identified during a Whipple procedure by careful dissection in the hepatoduodenal ligament, just above the first portion of the duodenum, where it bifurcates from the common hepatic artery and descends behind the duodenum 1. To identify the GDA, begin by exposing the anterior surface of the pancreas and identifying the common hepatic artery.
- Follow this vessel distally until you locate its bifurcation into the proper hepatic artery and the GDA.
- The GDA typically runs vertically downward along the posterior aspect of the duodenum, and its course can be confirmed by gentle palpation and visual inspection.
- Once identified, the GDA should be carefully isolated, doubly ligated, and divided to allow mobilization of the duodenum and pancreatic head. Proper identification of the GDA is crucial as inadvertent injury can lead to significant bleeding, and it serves as an important landmark for subsequent dissection steps, such as assessing margins, including the SMA (Retroperitoneal/uncinate) Margin, which is critical for accurate reporting 1. Anatomical variations are common, so it is essential to maintain awareness of possible aberrant arterial patterns during the dissection, ensuring accurate assessment and minimizing potential complications.
From the Research
Identifying the Gastroduodenal Artery (GDA) During a Whipple Procedure
- The GDA is a critical structure that needs to be identified and divided during a Whipple procedure 2
- Awareness of the vascular anatomy, variations, and pathology of the area is essential to achieve safe surgery and good outcomes 2
- The operation involves division of the GDA, which provides communication between the foregut and midgut blood supply 2
Preoperative and Intraoperative Considerations
- A review of preoperative imaging is important to identify potential variations in vascular anatomy 2
- An intraoperative gastroduodenal artery clamp test can help identify cases that may need additional procedures to preserve blood supply 2
- The use of illustrations and a systematic approach can help facilitate a streamlined and stepwise progression through the Whipple procedure 3
Potential Complications
- Hemorrhagic complications can occur after Whipple surgery, with the stump of the GDA being a common site of bleeding 4, 5
- Imaging and radiologic intervention can be used to manage postpancreatectomy hemorrhage 5
- Other complications, such as delayed gastric emptying and postoperative pancreatic fistula, can also occur after Whipple surgery 6