The following anastomosis are done in whipple procedure except?

Chitranjjan National Cancer Institute Kolkata - 2021

Medical & Surgical Nursing

Medium

Appeared in: Chitranjjan National Cancer Institute Kolkata - 2021

Explanation

Pancreatogastrectomy is the correct answer as it is not an anastomosis.
The suffix '-ectomy' signifies the surgical removal of an organ, in this case, the pancreas and stomach.
An anastomosis is a surgical connection between two structures, typically ending in '-ostomy' or being explicitly named as such.
The other options are all types of anastomoses performed to reconstruct the gastrointestinal tract after the resection part of the Whipple procedure.
The correct term for an anastomosis between the pancreas and stomach is a pancreatogastrostomy, not pancreatogastrectomy.

Option A: Hepatico-jejunostomy is a standard and essential anastomosis performed during a Whipple procedure.
Option C: Gastro-jejunostomy is a common anastomosis in a classic Whipple procedure, connecting the stomach to the jejunum.
Option D: A jejuno-jejunostomy is an anastomosis between two parts of the jejunum, often created to form a Roux-en-Y limb during reconstruction.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Surgical anastomoses in Whipple procedure (pancreaticoduodenectomy) as background academic context rather than a clinical decision trigger.
Nurses must closely monitor patients post-Whipple for signs of anastomotic leaks, a major life-threatening complication. This includes observing drain output for high amylase content (pancreatic leak) or bilious fluid (bile leak).
Delayed gastric emptying (DGE) is another common complication. Nursing care involves managing the nasogastric tube, monitoring for nausea/vomiting, and slowly advancing the diet as tolerated.
What if? If a patient's abdominal drain output suddenly increases and becomes cloudy with a high amylase level, the nurse should suspect a pancreatic fistula (anastomotic leak), immediately notify the surgical team, monitor vital signs for sepsis, and prepare for potential interventions like NPO status and further imaging.

How to Approach the Question

First, identify the keyword 'except'. This means you are looking for the option that does NOT belong.
The question asks about 'anastomosis'. Recall that an anastomosis is a surgical connection between two structures.
Analyze the suffix of each option. The suffix '-ostomy' or the term 'anastomosis' itself refers to a connection.
The suffix '-ectomy' refers to surgical removal.
Evaluate each option: Hepatico-jejunostomy, Gastro-jejunostomy, and Jejuno-jejunostomy are all connections (anastomoses).
Pancreatogastrectomy ends in '-ectomy', indicating removal, not a connection. This makes it the outlier and the correct answer.

Concept Tested & Keywords

Concept Tested: Surgical anastomoses in Whipple procedure (pancreaticoduodenectomy)
Stem keywords: Whipple procedure, anastomosis
Lead-in keywords: except
Negative lead-in flag: Question asks for the exception.