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Whipple Procedure

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by Kerr SJ

(Pancreaticoduodenectomy; Classic Whipple; PP Whipple; Pylorus-preserving Pancreaticoduodenectomy; Pylorus-preserving Whipple Procedure)

 

Reasons for Procedure

You may have this surgery to treat cancer of the pancreas, duodenum, or lower part of the bile duct. It may also be done to treat people with long-term inflammation of the pancreas.
 

What to Expect

Prior to Procedure

Before surgery, your doctor may do the following tests:
  • Physical exam
  • Blood tests
  • Echocardiogram (ECG) to check your heart function
  • Lung function tests to make sure your lungs are strong
  • Imaging tests to locate the cancer and make sure it has not spread
Your doctor may put you on a special diet before the surgery to help your body prepare. If you are not able to eat, you may need to go to the hospital several days before surgery. You will be given glucose and fluids through an IV.
Talk to your doctor about your medications, herbs, and dietary supplements. You may be asked to stop taking some medications up to one week before the procedure, like:
  • Anti-inflammatory drugs
  • Blood thinners
  • Antiplatelet drugs

Anesthesia

General anesthesia will be used. It will block any pain and keep you asleep during surgery.

Description of the Procedure

For open Whipple procedures, a large incision will be made in the abdomen. The head of the pancreas and the gallbladder, duodenum, and pylorus will be removed. Nearby lymph nodes may also be removed. The remaining pancreas and digestive organs will be reconnected. This will allow the digestive enzymes from the pancreas and stomach contents to flow into the small intestine. In some cases, the pylorus is not removed. The doctor will close the incision with stitches or staples. The incisions will be covered with bandages.
For laparoscopic procedures, a camera and small surgical instruments are inserted through small incisions into the abdomen. The organs can be removed and reconnected through the openings. After the area is carefully examined, the laparoscope will be removed. The doctor will close the incision with stitches or staples. The incisions will be covered with bandages.
You may have many small tubes placed after the procedure. Some will help drain fluid from the surgery site. Another tube may go into your stomach to help prevent nausea and vomiting. A tube may go to your intestines so you can receive nutrition.

Immediately After Procedure

After surgery, you will stay in the intensive care unit for several days. This will help the doctors and nurses monitor your progress.

How Long Will It Take?

4-8 hours

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

You will need to stay in the hospital until your intestines begin to work again. This usually takes two weeks. You may need to stay longer if there are any problems.

Post-procedure Care

At the Hospital
During surgery, your doctor may have placed a jejunostomy tube (j-tube). You will receive nutrients through this tube until your intestines are working normally. After the tube is removed, you can gradually progress to a soft diet, then to regular food.
Other tubes will be removed as you recover.
Preventing Infection
During your stay, the hospital staff will take steps to reduce your chance of infection, such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered
There are also steps you can take to reduce your chance of infection, such as:
  • Washing your hands often and reminding your healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision
At Home
This surgery will affect the way your body digests food. You may feel bloated or full after eating. You may have nausea and vomiting. Talk to your doctor or dietician to learn how you should eat. You may need to start new medications to help with digestion and medications to help control your blood sugar.
Ask your doctor about when it is safe to shower, bathe, or soak in water.
 

RESOURCES

National Cancer Institute
http://www.cancer.gov

Pancreatic Cancer Action Network
http://www.pancan.org

 

CANADIAN RESOURCES

Canadian Cancer Society
http://www.cancer.ca

Pancreatic Cancer Canada
http://www.pancreaticcancercanada.ca

 

References


Halgreen H, Pedersen NT, Worning H. Symptomatic effect of pancreatic enzyme therapy in patients with chronic pancreatitis. Scand J Gastroenterol. 1986;21(1):104.


Having your operation for pancreatic cancer. CancerHelp UK website. http://www.cancerhelp.org.uk/type/pancreatic-cancer/treatment/surgery/having-your-operation-for-pancreatic-cancer. Accessed February 27, 2014.


Learn about pancreatic cancer: nutrition following pancreatic surgery. Pancreatic Cancer Action Network website. Available at: http://www.pancan.org/section%5Ffacing%5Fpancreatic%5Fcancer/learn%5Fabout%5Fpan%5Fcancer/diet%5Fand%5Fnutrition/After%5FWhipple%5Fprocedure.php. Accessed February 27, 2014.


Learn about pancreatic cancer: Whipple procedure. Pancreatic Cancer Action Network website. Available at: http://www.pancan.org/section%5Ffacing%5Fpancreatic%5Fcancer/learn%5Fabout%5Fpan%5Fcancer/treatment/surgery/Whipple%5Fprocedure.php. Accessed February 27, 2014.


Pancreatic cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 25, 2014. Accessed February 27, 2014.


Recovering from a Whipple’s operation. CancerHelp UK website. Available at: http://www.cancerhelp.org.uk/about-cancer/cancer-questions/recovering-from-a-whipples-operation. Accessed February 27, 2014.


Singh VV, Toskes PP. Medical therapy for chronic pancreatitis pain. Curr Gastroenterol Rep. 2003;5(2):110.


Surgery for pancreatic cancer. American Cancer Society website. Available at: http://www.cancer.org/cancer/pancreaticcancer/detailedguide/pancreatic-cancer-treating-surgery. Updated February 5, 2014. Accessed February 27, 2014.


What you need to know about cancer of the pancreas. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/wyntk/pancreas.pdf. Accessed February 27, 2014.


6/6/2011 DynaMed's Systematic Literature Surveillance Available at: http://www.ebscohost.com/dynamed: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.

 

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