Whipple Procedure

The Whipple procedure is a complex surgery to remove pancreatic cancer at the “head” of your pancreas. The head is an important point in your digestive system. It’s where several organs meet.

Cancer in any of these organs can spread to the others. So, Whipple surgery removes the pancreas head and other parts where the cancer might spread. These include your:

• Duodenum (first part of your small intestine)
• Common bile duct (feeds into the head of your pancreas)
• Gallbladder (connects to your common bile duct)
• Surrounding lymph nodes (usually the first place cancer spreads)
• Pylorus (bottom part of your stomach)

After removing these parts, your surgeon will reconnect the remaining parts. That way, your digestive system can continue to work.

Another word for the Whipple procedure is “pancreaticoduodenectomy.”

What is a modified Whipple procedure?

The modified Whipple procedure (pylorus-sparing Whipple) leaves your stomach intact. This might be an option if your condition doesn’t appear to involve your stomach.

With the modified Whipple procedure, your surgeon doesn’t touch your pylorus. So, it’s less likely to affect your stomach function afterward. Surgeons choose this option whenever possible.

What does the Whipple procedure treat?

Surgeons mainly use the Whipple procedure to remove pancreatic cancer and other cancerous tumors near the head of your pancreas. These include:

• Pancreatic adenocarcinoma
• Pancreatic neuroendocrine tumors
• Intraductal papillary mucinous neoplasms
• Duodenal cancer
• Ampullary cancer
• Bile duct cancer

Your healthcare provider might recommend the Whipple procedure to treat other conditions that affect this area of your body. For example, chronic pancreatitis may affect nearby organs.

Who is not a candidate for the Whipple procedure?

You might not get Whipple surgery if:

• You have cancer in other parts of your pancreas, like the “body” or “tail”
• The cancer has spread beyond the original site
• The tumor is in a location that’s hard to operate on
• You’re not in good physical condition for the surgery

What happens before the Whipple procedure?

Before scheduling the Whipple procedure, your healthcare team will:

• Make sure the cancer is operable: They may use imaging tests, like a CT scan or MRI. Or they might do a minor procedure called a staging laparoscopy. Your provider inserts a tiny camera into your belly to look at your organs.
• Discuss other cancer treatments: Your provider might recommend other cancer treatments, like chemotherapy or radiation therapy, before surgery. Or they might suggest getting these treatments after surgery.
• Talk to you about the operation: Your provider will sit down with you to discuss the risks and benefits of the procedure. They’ll ask for your informed consent. They’ll also let you know how to prepare for the surgery.
• Get your body in the best possible condition: Before the operation, you might need medical nutrition therapy or treatment for another condition. If the tumor is blocking your bile duct, you might need a stent.

What happens during the Whipple procedure?

You’ll have general anesthesia during the procedure, so you’ll sleep through it. Your anesthesiologist will use other pain-blocking techniques to keep you comfortable. These may include nerve blocks and/or painkillers through an IV line. Your surgical team will monitor your vital signs.

You may have:

• Laparoscopic or robotic surgery: Laparoscopy and robotic surgery are minimally invasive techniques. Your surgeon uses a tiny camera (laparoscope) to look at your organs through a small cut (incision). They operate through other small cuts. The recovery might be easier, but this approach takes advanced skills.
• Open abdominal surgery: Your surgeon makes one long cut in your belly to expose your organs. This makes them easier to access. The Whipple procedure is complicated. So, some surgeons feel more confident using this method.

Whipple procedure steps

Your surgeon will:

1. Remove your gallbladder and the part of your bile duct that connects it to your pancreas.
2. Remove the affected portion of your pancreas.
3. Divide your small intestine and remove your duodenum.
4. Remove the lower section of your stomach (if needed).
5. Remove nearby lymph nodes.
6. Create a new connection (anastomosis) between your pancreatic duct and small intestine.
7. Create a new connection between your remaining bile duct and small intestine.
8. Create a new connection between your stomach and small intestine (gastrojejunostomy).
9. Save and send all removed parts to a lab to test them for cancer cells.

How long does a Whipple procedure take?

You’ll spend five to eight hours in surgery for the Whipple procedure.

What are the risks and benefits of the Whipple procedure?

Whipple surgery is your best chance of surviving pancreatic cancer. But surgery can only treat about 1 in 5 people diagnosed with this cancer. That’s because this type of cancer is hard to catch in the early stages. Surgery only works if the cancer hasn’t already spread. But if your surgeon can remove it all, this may stop it from spreading.

The Whipple procedure does have risks and side effects. Recovery can be long and complicated. Your digestive system may take months to adjust. It may never be the same.

Complications of a Whipple procedure

Most complications are temporary and treatable. But some can be lasting and affect your quality of life.

Complications of the Whipple procedure can include:

• Anastomotic leaks: The Whipple procedure involves three new surgical connections between your organs. Complications can occur if these connections leak.
• Changes in digestion: After surgery, you may have trouble digesting certain foods. This could be short-term or long-term. Some people also experience changes in bowel habits.
• Delayed gastric emptying: Damage to nerves in your stomach can cause it to hold onto food for too long. This is often a temporary problem that goes away when you’re fully recovered.
• Visceral artery pseudoaneurysm: A hole in your visceral artery could allow blood to leak out. This can form a pool with a weak wall around it. If the wall breaks, it could cause a hemorrhage.
• Endocrine/exocrine insufficiency: Your pancreas might not be able to make enough enzymes or hormones after surgery. This can lead to exocrine insufficiency and/or diabetes.
• Biliary stricture: Scar tissue from surgery on your bile duct can cause it to narrow too much. This can create a blockage. Your surgeon might have to operate again to remove the scar tissue.

What happens after the Whipple procedure?

You’ll spend one to two weeks recovering in the hospital after Whipple surgery. You’ll have pain relief as needed. You may have a feeding tube or get nutrition through an IV while your digestive system heals.

Your healthcare team will run tests to see if they removed all the cancer. Depending on what they find, they might suggest other treatments after you’ve fully recovered.

Whipple procedure recovery

Most people can return to their regular activities after about six weeks. But it may take several months before you feel fully recovered. You might feel very tired during this time.

Many people find they can eventually return to eating normally. But others might need to make long-term changes. If your digestive troubles continue, talk to your provider. It’s important to get enough nutrition while you’re recovering.

Whipple procedure survival rate

Most people survive the Whipple procedure itself. Survival rates after the procedure depend on:

• The type of cancer you have
• The stage
• Other factors

Each case is different. Your healthcare provider can give you more information on your situation. In general, Whipple surgery has a better overall outlook compared to other treatments for pancreatic cancer.