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Whipple Procedure

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

Definition

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

Gallbladder
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

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.

Possible Complications

If you are planning to have a Whipple procedure, your doctor will review a list of possible complications. These may include:

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

Complications that occur during surgery may include:

Leaking from connections made in the intestines
Damage to other organs

Smoking may increase the risk of complications.

Discuss these risks with your doctor before surgery.

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 medicines, herbs, and dietary supplements. You may be asked to stop taking some medicines up to one week before the procedure, like:

Aspirin and other nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen
Blood-thinning drugs
Anti-platelet drugs

Anesthesia

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

Description of the Procedure

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.

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?

Pain or soreness during recovery will be managed with pain medicine.

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.

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 medicines to help with digestion and medicines to help control your blood sugar.

Ask your doctor about when it is safe to shower, bathe, or soak in water.

Be sure to follow your doctor’s instructions.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

Signs of infection, such as fever or chills
Redness, swelling, increasing pain, bleeding, or discharge from the incision
Nausea and/or vomiting
Pain that is not controlled with the medicines you have been given

In case of 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.

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 . Updated December 18, 2012. Accessed April 2, 2013.

Learn about pancreatic cancer: nutrition after a Whipple procedure. 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 April 2, 2013.

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 April 2, 2013.

Pancreatic cancer: surgery. American Cancer Society website. Available at: http://www.cancer.org/cancer/pancreaticcancer/index . Accessed April 2, 2013.

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#diet . Updated January 9, 2013. Accessed April 2, 2013.

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

What you need to know about cancer of the pancreas. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/wyntk/pancreas.pdf . Updated May 2010. Accessed April 2, 2013.

6/6/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : 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: Marcin Chwistek, MD
Review Date: 03/2013 -
Update Date: 00/31/2013 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.