# Whipple Procedure With Preservation of the Right Gastroepiploic Artery After an Ivor Lewis Esophagectomy

## TL;DR

A patient who had prior esophagectomy successfully underwent a modified Whipple procedure preserving key arteries to maintain stomach blood supply.

## Contribution

Demonstrates a modified Whipple procedure preserving gastroduodenal and right gastroepiploic arteries in patients with prior Ivor Lewis esophagectomy.

## Key findings

- Preservation of gastroduodenal and right gastroepiploic arteries during Whipple procedure is feasible in patients with prior esophagectomy.
- This approach helps maintain gastric blood supply, which is critical after prior esophagectomy.
- Pancreaticoduodenectomy can be safely performed in patients with prior Ivor Lewis procedure using this modified technique.

## Abstract

In patients with a history of Ivor Lewis procedure for esophageal cancer, the majority of the arteries that supply the stomach are ligated. Therefore, the blood supply of the stomach becomes dependent on the gastroduodenal artery. The arterial supply of the stomach could be compromised if a patient undergoes another surgical procedure, such as a Whipple procedure, that involves ligation of the gastroduodenal artery.

A 73-year-old woman with a history of an Ivor Lewis procedure for esophageal adenocarcinoma presented to the clinic with symptoms of abdominal pain, vomiting, and jaundice. Upon workup, the CT scan revealed a lesion in the pancreatic head. She underwent a Whipple procedure with the preservation of the gastroduodenal artery, and therefore, the right gastroepiploic artery.

The blood supply to the gastric pull-up reconstruction following esophagectomy is dependent mostly on the right gastroepiploic artery. During the Whipple procedure, the gastroduodenal artery is cut and ligated. This would not be suitable for patients with a history of esophagectomy, as it would compromise the blood supply to the stomach.

Pancreaticoduodenectomy can be successfully performed in patients who have had an Ivor Lewis esophagectomy with the gastroduodenal and right gastroepiploic arteries preserved.