Whipple Procedure

What is the Whipple procedure?

The Whipple procedure is a surgery to remove a cancerous tumor from the head (right side) of your pancreas. It removes the head of the pancreas, the first portion of your small intestine called the duodenum, part of your bile duct and the gallbladder. A loop of your small intestine is then brought up and sewn to the remainder of your pancreas, the bile duct and the stomach.

The Whipple procedure is the most common surgery to remove pancreatic cancer. The purpose is to try and stop the cancer from spreading (metastasizing) to other organs. Around 20% of people with pancreatic cancer are eligible for this surgery. If the cancer has already spread (metastasized), then there’s no benefit to the Whipple.

Another name for the Whipple procedure is pancreaticoduodenectomy.

What does the Whipple procedure treat?

Pancreatic cancer is the most common reason why surgeons recommend the Whipple procedure. But this surgery can also treat:

• Pancreatic cysts.
• Pancreatitis.
• Small bowel cancer.
• Trauma to your pancreas or small intestine.
• Ampullary cancer.
• Bile duct cancer.
• Pancreatic neuroendocrine tumors.

How should I prepare for the Whipple procedure?

If you have cancer, you may go through chemotherapy before you have the surgery.

Your surgeon will instruct you to stop taking certain medications in the days leading up to your surgery. You should also:

• Avoid food and drinks for eight hours before going to the hospital, unless directed otherwise.
• Quit smoking — even if it’s just for two weeks before the Whipple procedure — to improve heart and lung health.
• Stop taking herbal supplements for one to two weeks before the surgery as directed by your healthcare provider.
• Avoid Viagra® or other medications for erectile dysfunction at least 24 hours before your Whipple procedure.
• You should take certain (but not all) blood pressure medications with a sip of water as instructed by your provider.

Once at the hospital, a provider will insert an IV line into your arm. This allows them to inject fluids and medications you’ll need during your surgery.

What happens during a Whipple procedure?

An anesthesiologist will give you general anesthesia to help you sleep through your surgery.

Here are the Whipple procedure steps:

1. Your surgeon will make a large incision in your belly (or a few small ones if it’s a laparoscopic/robotic surgery).
2. They’ll remove the affected portion of your pancreas. They’ll also remove your duodenum (the first section of your small intestine), the lower section of your bile duct, your gallbladder and, sometimes, a part of your stomach.
3. Your surgeon will attach what’s left of your pancreas and bile duct to your small intestine.
4. Finally, they reattach your small intestine to your stomach, ensuring that food can pass through your entire digestive system.

How long does a Whipple procedure take?

The Whipple procedure is a complex surgery that takes about five to eight hours.

What happens after the Whipple procedure?

The Whipple procedure is a significant surgery. Recovery from the procedure will take some time.

During your hospital stay, your care team will manage your pain and watch for signs of infection or other complications. You’ll be on a clear liquid diet for a few days until your healthcare providers feel that you’re ready to try solid foods. As soon as the first day after surgery, you should start doing lung exercises (incentive spirometry) and moving about your room. Just be sure to call a nurse or physical therapist for help getting up so you don’t fall.

What are the benefits of the Whipple procedure?

Pancreatic cancer is notably tough to treat because it’s hard to detect in its early stages. But if you catch it before the cancer spreads, a Whipple procedure offers hope for long-term survival.

Is the Whipple procedure worth it?

For pancreatic cancer, a Whipple procedure is often the only hope for long-term survival. But cure rates depend on certain factors like the location and stage of your tumor. Ask your surgeon whether they think a Whipple procedure will improve or prolong your life.

For neuroendocrine tumors, a Whipple procedure is the treatment of choice. It offers a chance for a cure and long-term survival. Even in metastatic disease where the tumor spreads outside of your pancreas, a Whipple has been shown to improve survival.

For noncancerous reasons, a Whipple can significantly improve your quality of life.

Talking with your healthcare provider can help you weigh the risks and benefits of this treatment.

What are the risks or complications of the Whipple procedure?

As many as one-third of people who go through the Whipple procedure have complications, which include:

• Diabetes (temporary or permanent).
• Fistulas (tunneling from one body part to another).
• Bowel leakage.
• Bleeding.
• Infection.
• Difficulty digesting some foods.
• Weight loss.
• Bowel changes.
• Constipation.

What is the recovery time?

The Whipple procedure is a major surgery and recovery will take time. Most people need to stay in the hospital for about five to seven days. If there are no complications, you should be able to resume your normal activities in about four to six weeks.

Will I need to eat a specific diet after my Whipple procedure?

In the days after your Whipple procedure, you’ll be on a clear liquid diet. Your surgeon will decide when you’re ready to have solid foods. For a while, you’ll want to eat soft foods that are easy to digest. Talk to your healthcare provider about foods they recommend.

What medications will I need to take?

After a Whipple procedure, your surgeon will prescribe analgesics to manage your pain. You should only need these for a week or two. They’ll also prescribe a pancreatic enzyme to help with digestion. In some cases, they might give you medications to prevent blood clots in your legs.

What’s the Whipple procedure survival rate?

The Whipple procedure survival rate has improved a lot in the last few decades. Thirty years ago, between 5% and 15% of people who went through the Whipple procedure died from complications. Now, the mortality rate is about 1% to 3%.

When should I call my healthcare provider?

Contact your surgical team if the following happens:

• Your stitches get loose, or they open.
• You develop a fever.
• Your incision looks red, feels warm, leaks pus or hurts worse.
• Your bowel movements are irregular.

What is the average life expectancy after a Whipple procedure?

Many factors determine your life expectancy after a Whipple procedure, like how far the cancer spread before your surgery. These statistics also vary depending on why you needed the procedure in the first place.

Most people who have the Whipple procedure can increase their life expectancy to some degree. But it’s different for everyone. If you have a noncancerous condition — or received a very early pancreatic cancer diagnosis — you may have a normal life expectancy. If cancer has spread to nearby lymph nodes or other areas, the Whipple procedure can lengthen your life by a few years. The five-year survival rate for these situations is between 20% to 25%.

A note from Cleveland Clinic

Pancreatic cancer is a devastating diagnosis — like a massive storm cloud that shadows every step you take. And you know it’s only a matter of time until it rains enough to cover your whole world. The Whipple procedure is a silver lining, offering hope for brighter days. Remember, you’re not alone. Lean on the support of your loved ones and reach out to your healthcare provider for any resources and assistance you need.