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by Kerr SJ

Definition

A Whipple procedure is complex surgery to remove part of the pancreas along with the:

  • Gallbladder and common bile duct
  • Top part of the small intestine called the duodenum
  • Portion of the stomach called the pylorus—when the pylorus is not removed, the procedure is known as a pylorus-preserving Whipple procedure.
  • Surrounding lymph nodes
The Pancreas
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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 chronic pancreatitis .

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Long-term difficulty with digestion
  • Chronic abdominal pain
  • Chronic need for pancreatic enzyme supplementation
  • Diabetes

Complications that occur as a result of surgery may include:

  • Leaking from connections made in the intestines
  • Damage to other organs
  • Bleeding
  • Infection
  • Reaction to anesthesia
  • Blood clots

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications. such as:

What to Expect

Prior to Procedure

Before surgery, your doctor may do the following tests:

  • Blood tests
  • ECG
  • Lung function tests to make sure your lungs are strong
  • Imaging tests to locate the cancer and make sure it has not spread

You may be put 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.

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 incision will be closed 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 incision will be closed 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 through your nose 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 2 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 dietitian to learn how you should eat. Follow your doctor's instructions.

Call Your Doctor

Contact your doctor if your recovery is not progressing as expected or you develop complications, such as:

  • Signs of infection, such as fever or chills
  • Redness, swelling, increasing pain, bleeding, or discharge from the incision
  • Pain that is not controlled with the medications you were given
  • New or worsening:
    • Diarrhea
    • Weigh loss
    • Nausea and/or vomiting
  • Symptoms of diabetes, which may include:
    • Frequent urination
    • Excessive thirst
    • Increased hunger
    • Slow wound healing

If you think you have an emergency, call for medical help right away.

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.

Nutrition following pancreatic surgery. Pancreatic Cancer Action Network website. Available at: https://www.pancan.org/section-facing-pancreatic-cancer/learn-about-pan-cancer/diet-and-nutrition/after-a-whipple-procedure. Accessed March 6, 2018.

Pancreatic cancer. EBSCO DynaMed Plus website. Available at:  https://www.dynamed.com/topics/dmp~AN~T114527/Pancreatic-cancer  . Updated January 22, 2018. Accessed March 6, 2018.

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 March 14, 2016. Accessed March 6, 2018.

What you need to know about cancer of the pancreas. National Cancer Institute website. Available at: http://www.cancer.gov/publications/patient-education/pancreas.pdf. Accessed March 6, 2018.

Whipple procedure (pancreaticoduodenectomy). Pancreatic Cancer Action Network website. Available at: https://www.pancan.org/section-facing-pancreatic-cancer/learn-about-pan-cancer/treatment/surgery/whipple-procedure-pancreaticoduodenectomy. Accessed March 6, 2018.

6/3/2011 DynaMed's Systematic Literature Surveillance  https://www.dynamed.com/topics/dmp~AN~T905141/Treatment-for-tobacco-use  : 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.

Revision Information

  • Reviewer: EBSCO Medical Review Board Alan Drabkin, MD
  • Review Date: 03/2018
  • Update Date: 02/27/2014