Whipple

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Whipple
Baylor College of Medicine

What is a Whipple procedure?

Also called a pancreaticoduodenectomy, the Whipple procedure is performed to address chronic pancreatitis and cancer of the pancreas, ampulla of Vater, duodenum, and the distal bile duct. The Whipple procedure involves removing the cancerous parts of the pancreas, duodenum, common bile duct, and if required, part of the stomach.

What do I need to do before surgery?

Please contact your insurance company to verify the coverage and determine whether a referral is required. You will be asked to pre-register with the appropriate hospital and provide demographic and insurance information. This must be completed at least five to ten days before the surgery date. Your surgeon will give you specific instructions on how to prepare for your surgery.

What happens on the day of surgery?

You will report to a pre-operative nursing unit, where you will change into a hospital gown. A nurse will review your chart and confirm that all paperwork is in order. You will be taken to a pre-operative holding area, where an anesthesiologist will start an IV. Before any medications are administered, your surgeon will verify your name and the type of procedure you are having. You will then be taken to the operating room. After the appropriate form of anesthesia is administered, surgery will be performed.

What type of anesthesia will be used?

You will have a pre-operative interview with an anesthesiologist, who will ask you questions regarding your medical history. A Whipple procedure is performed with general anesthesia, which will keep you asleep during surgery.

What happens during the surgery, how is the surgery performed?

In the beginning of the procedure, the surgeon will decide whether the tumor can be removed. The pancreas is examined by an open incision or by laparoscopic instruments. If the cancer has not spread to surrounding tissues, your surgeon will continue to perform the Whipple procedure.

The overall goal of the Whipple procedure is to remove the head of the pancreas and the attached section of the small intestine. First, the end of the stomach is divided off and detached. This part the stomach leads to the small intestine, where the pancreas and bile duct both attach. In the next step, the cancerous head of the pancreas is cut, leaving it attached to the small intestine. Farther down from the pancreas attachment site, the small intestine is divided to free the section of the intestine that is connected to the pancreatic head. The bile duct is the last connection to be cut. This leaves the gallbladder and common bile duct attached to the removed section.

The next steps reconnect the intestinal tract. The stomach is connected to the small intestine, and the bile duct and remaining portion of the pancreas are reattached.

Several tubes may be implanted for postoperative care. To prevent tissue fluid from accumulating in the operated site, a temporary drain leading out of the body will be implanted. Also, a G-tube leading out of the stomach will be inserted to help prevent nausea and vomiting, and a J-tube inserted into the small intestine will serve as a channel for supplementary feeding.

What happens after the surgery?

Once the surgery is completed, you will be taken to a post-operative or recovery unit where a nurse will monitor your recovery. It is important that your bandages be kept clean and dry. You will experience pain in your abdomen so your surgeon will give you a prescription for pain medication.

How long will I be in the hospital?

The length of stay varies, but most patients remain in the hospital for about two to three weeks.

What are the risks associated with a Whipple procedure?

As with any surgery, there are risks such as bleeding, infection, or an adverse reaction to anesthesia. Biliary and pancreatic leaks may also occur. Because the pancreas will not function as effectively, postoperative diabetes and the occurrence of fatty stool may develop. This depends upon how much of the pancreas remains. Your surgeon will inform you of the risks prior to surgery.

What should I watch out for?

Be sure to call your doctor if any of the following symptoms appear:
• Fever
• Worsening pain
• Redness or swelling around the incision
• If the incision is warm to the touch
• Drainage from the incision

Will there be scar(s)?

There will be a midline scar on your abdomen.
When can I return to work and resume normal activities?

This varies from patient to patient. Patients experience pain and weakness after the Whipple procedure. Eating and finding the right foods will be difficult for the first few weeks. You may also experience nausea and constipation. Because of these difficulties, you will probably be unable to resume work and normal activities within the first month of recovery. After the first month, you will slowly begin to feel normal.

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