(Pancreaticoduodenectomy; Classic Whipple; PP Whipple; Pylorus-preserving Pancreaticoduodenectomy; Pylorus-preserving Whipple Procedure)
DefinitionA Whipple procedure is complex surgery to remove part of the pancreas along with the:
- Gallbladder and common bile duct
- 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
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Reasons for ProcedureYou 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 ComplicationsProblems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Long-term difficulty with digestion
- Chronic abdominal pain
- Chronic need for pancreatic enzyme supplementation
- Leaking from connections made in the intestines
- Damage to other organs
- Reaction to anesthesia
- Blood clots
What to Expect
Prior to ProcedureBefore 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
- Anti-inflammatory drugs
- Blood thinners
- Antiplatelet drugs
AnesthesiaGeneral anesthesia will be used. It will block any pain and keep you asleep during surgery.
Description of the ProcedureFor open Whipple procedures, 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. The incisions will be covered with bandages.For laparoscopic procedures, a camera and small surgical instruments are inserted through small incisions into the abdomen. The organs can be removed and reconnected through the openings. After the area is carefully examined, the laparoscope will be removed. The doctor will close the incision with stitches or staples. The incisions will be covered with bandages.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 ProcedureAfter 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?Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.
Average Hospital StayYou 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 CareAt the HospitalDuring 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.Preventing InfectionDuring your stay, the hospital staff will take steps to reduce your chance of infection, such as:
- Washing their hands
- Wearing gloves or masks
- Keeping your incisions covered
- Washing your hands often and reminding your healthcare providers to do the same
- Reminding your healthcare providers to wear gloves or masks
- Not allowing others to touch your incision
Call Your DoctorCall your doctor if any of these occur:
- Signs of infection, such as fever or chills
- Redness, swelling, increasing pain, bleeding, or discharge from the incision
- Pain that is not controlled with the medications you have been given
- New or worsening:
- Weigh loss
- Nausea and/or vomiting
- Symptoms of diabetes, which may include:
- Frequent urination
- Excessive thirst
- Increased hunger
- Slow wound healing
National Cancer Institute
Pancreatic Cancer Action Network
Canadian Cancer Society
Pancreatic Cancer Canada
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6/6/2011 DynaMed's Systematic Literature Surveillance Available at: http://www.ebscohost.com/dynamed: 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.
- Reviewer: Michael Woods, MD
- Review Date: 02/2014
- Update Date: 02/27/2014