Whipple Procedure (Pancreaticoduodenectomy)
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What is the Whipple procedure?
The Whipple procedure (also called a pancreaticoduodenectomy) is a surgery to remove a cancerous tumor from the head (right side) of your pancreas to stop it from spreading to other organs (metastasizing). Around 15% to 20% of people with pancreatic cancer are eligible for this surgery.
Where is the pancreas and what does it do?
Your pancreas is an important organ located in your abdomen. It’s shaped a bit like a fish. The widest part on the right is called the head. The middle section is called the neck or body, and the thin end is referred to as the tail. Your pancreas makes hormones, helps your body digest food and controls your sugar levels.
What is pancreatic cancer?
This type of cancer is caused by a growth (tumor) in your pancreas. The tumor usually grows in the head, neck or body of your pancreas. Few grow in the tail. Pancreatic cancer is primarily caused by smoking and most of those diagnosed are between the ages of 60 and 80 years.
Yearly in the U.S., about 57,000 people are diagnosed with pancreatic cancer and there are around 46,000 deaths. Only roughly 8.5% of people with this type of cancer live for another five years after their diagnosis.
When is a Whipple procedure done?
Pancreatic cancer is the most common reason that your surgeon performs a Whipple procedure. However, this operation may also be needed for:
- Pancreatic cysts.
- Small bowel cancer of the duodenum.
- Trauma to the pancreas or small intestine.
- Ampullary cancer.
- Bile duct cancer.
- Neuroendocrine tumors.
Is the Whipple procedure inpatient or outpatient?
The Whipple procedure is a major inpatient surgery. You’ll need to recover in the hospital for about a week.
Who performs the surgery?
A team of nurses, anesthesiologists and anesthetists assist your surgeon during the Whipple procedure.
What happens before the Whipple procedure?
If you have cancer, you may go through radiation or 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 for your Whipple procedure, 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.
- Not take Viagra® or other medications for erectile dysfunction at least 24 hours before a 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, your nurse will insert an intravenous line (IV) into your arm to inject fluids and medications you’ll need during the surgery. Additionally, an epidural catheter or spinal injection may be necessary. They block your nerves, helping decrease pain after surgery.
Where is the Whipple procedure performed?
The Whipple procedure is a complex operation with a high risk of major complications. It takes a lot of skill and experience to perform the surgery and manage any complications. To get the best outcome, you’ll want to have a very experienced surgeon and be in a hospital that performs at least 15-20 Whipple procedures each year.
Is the Whipple procedure an open or minimally invasive surgery?
An open surgery is one where the surgeon cuts one large opening. Minimally invasive (laparoscopic) surgery uses several smaller cuts (incisions). With a minimally invasive surgery, there’s usually less blood loss, fewer complications and a faster recovery time. Although a laparoscopic surgery is ideal for many indications, the Whipple procedure is usually an open surgery.
What are the steps of the Whipple procedure?
The Whipple procedure can be summed up in a few steps:
- A large incision will be made in your abdomen (or there will be a couple small ones if it’s a laparoscopic surgery).
- Your surgeon will remove the portion of your pancreas where the tumor is located along with the small bowel surrounding it (the duodenum), the lower section of the bile duct, the gall bladder and sometimes a part of your stomach.
- What’s left of your pancreas and bile duct get attached to your small intestine.
- The small intestine is then reattached to your stomach, ensuring that food can pass through the entire digestive tract.
How long does the Whipple procedure last?
The Whipple procedure is a complicated surgery that takes 4-12 hours.
Will I be asleep during the Whipple procedure?
Yes, you will be under general anesthesia for the Whipple procedure. This treatment makes you unconscious and insensitive to pain or other stimuli.
What should I expect after the Whipple procedure?
The Whipple procedure is a significant surgery. Recovery from the procedure will take some time.
You’ll have pain for a while after your Whipple procedure. 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 introduce solid foods. As soon as you feel up to it, 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.
Risks / Benefits
What are the advantages of the Whipple procedure?
A Whipple procedure increases your chances of long-term survival with pancreatic cancer. Unfortunately, very few people survive pancreatic cancer. Only about 8.5% of people with pancreatic cancer live for five years. If you have the Whipple procedure, your chances increase to 25%.
Does a Whipple procedure cure cancer of the pancreas?
A Whipple procedure is often the only hope for a cure from pancreatic cancer. However, cure rates depend on the location and stage of your tumor, as well as other individual factors. Ask your surgeon about whether they think a Whipple procedure will cure your pancreatic cancer.
What are the potential Whipple procedure complications?
As many as one-third of people who go through the Whipple procedure have complications, which include:
- Diabetes. This can be temporary or permanent.
- Problems with the fistulas.
- Bowel leakage.
- Leakage from the organs involved.
- Difficulty digesting some foods.
- Weight loss.
- Bowel changes.
Recovery and Outlook
What’s the survival rate for a Whipple procedure?
The survival rate for a Whipple procedure 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%.
How long will I be in the hospital?
Following surgery, you’ll recover in the hospital for about a week. During this hospital stay, your care team will monitor your pain levels and watch for complications.
How long does it take to recover from the Whipple procedure?
It’s a major surgery and recovery will take time. If there are no complications, you should be able to resume your normal activities in about 4-6 weeks.
What should my diet be after the Whipple procedure?
In the days following your Whipple procedure you’ll be on a clear, liquid diet. Your surgeon will decide when you’re ready to introduce solid foods. For a while, you will 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 medications to help manage your pain. You may also be given medications to prevent clots in your legs.
When to Call the Doctor
When should I contact my surgeon?
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.
When should I go to the emergency department?
Call emergency services or go to the nearest emergency department right away if you experience any of the following problems:
- High fever that doesn’t get better with medicine.
- Stroke symptoms — slurred speech, numbness, weakness, loss of balance and/or vision problems.
- Trouble breathing/shortness of breath, or if you stopped breathing for any reason.
- Severe chest pain or pressure.
- Any pain that is so severe that you can’t stand it.
- Injury to your head, neck or spine.
- Loss of consciousness (if you pass out/faint).
- Sudden weakness, especially if you can’t speak or move.
- Dizziness that doesn’t stop.
- Poisoning or an overdose.
- Severe allergic reaction.
- Severe burn, electric shock or lightning strike.
- Coughing or throwing up blood.
- Heavy bleeding.
A note from Cleveland Clinic
The Whipple procedure offers hope to people with pancreatic cancer. Removing the tumor can increase the quality and length of your life. Have your Whipple procedure performed by an experienced surgeon at a well-established hospital. It’s appropriate to ask your surgeon about how many times they’ve performed the procedure (try to find one who has done it 15 or more times).
Pancreatic cancer can feel like a devastating diagnosis. Fortunately, a Whipple procedure might extend your life expectancy.
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