(Pancreaticoduodenectomy; Classic Whipple; PP Whipple; Pylorus-preserving Pancreaticoduodenectomy; Pylorus-preserving Whipple Procedure)En Español (Spanish Version)
A Whipple procedure is complex surgery to remove part of the pancreas along with the:
- Top part of the small intestine (duodenum)
- Portion of the stomach (pylorus)—Sometimes the pylorus is not removed. This is known as a pylorus-preserving Whipple procedure.
- Surrounding lymph nodes
© 2011 Nucleus Medical Media, Inc.
Reasons for Procedure
You 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.
If you are planning to have a Whipple procedure, your doctor will review a list of possible complications. These may include:
- Leaking from connections made in the intestines during surgery
- Damage to other organs
- Long-term difficulty with digestion
Factors that may increase the risk of complications include:
Discuss these risks with your doctor before surgery.
What to Expect
Prior to Procedure
Before surgery, your doctor may do the following tests:
- Physical exam
- Blood tests
- Chest x-ray
- 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
Your doctor may put you on a special diet before the surgery to help your body prepare. If you are not able to eat, you may need to go to the hospital several days before surgery. You will be given glucose and fluids through an IV.
Talk to your doctor about your medicines, herbs, and dietary supplements. You may be asked to stop taking some medicines up to one week before the procedure, like:
- Aspirin and other nonsteroidal anti-inflammatory drugs (eg, ibuprofen, naproxen)
- Blood-thinning drugs, such as warfarin (Coumadin)
- Anti-platelet drugs, such as clopidogrel (Plavix)
General anesthesia will be used. It will block any pain and keep you asleep during surgery.
Description of the Procedure
The doctor will make a large incision 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.
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 Procedure
After 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?
How Much Will It Hurt?
Pain or soreness during recovery will be managed with pain medicine.
Average Hospital Stay
You 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.
At the Hospital
During 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.
This surgery will affect the way your body digests food. You may feel bloated or full after eating. You may have nausea and vomiting. Talk to your doctor or dietician to learn about how you should eat. You may need to start new medicines to help with digestion and medicines to help control your blood sugar.
Ask your doctor about when it is safe to shower, bathe, or soak in water.
Be sure to follow your doctor’s instructions.
Call Your Doctor
After you leave the hospital, contact your doctor if any of the following occurs:
- Signs of infection (eg, fever, chills)
- Redness, swelling, increasing pain, bleeding, or discharge from the incision
- Nausea and/or vomiting
- Pain that is not controlled with the medicines given
In case of an emergency, CALL 911.
National Cancer Institute
Pancreatic Cancer Action Network
Canadian Cancer Society
Pancreatic Cancer Canada
Carson-DeWitt R. Surgical procedures for pancreatic cancer. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topic&ID=81. Updated September 2010. Accessed January 13, 2011.
Having your operation for pancreatic cancer. CancerHelp UK website. http://www.cancerhelp.org.uk/type/pancreatic-cancer/treatment/surgery/having-your-operation-for-pancreatic-cancer. Updated November 2009. Accessed January 13, 2011.
Learn about pancreatic cancer: nutrition after a Whipple procedure. Pancreatic Cancer Action Network website. Available at: http://www.pancan.org/section_facing_pancreatic_cancer/learn_about_pan_cancer/diet_and_nutrition/After_Whipple_procedure.php. Accessed January 13, 2011.
Learn about pancreatic cancer: Whipple procedure. Pancreatic Cancer Action Network website. Available at: http://www.pancan.org/section_facing_pancreatic_cancer/learn_about_pan_cancer/treatment/surgery/Whipple_procedure.php. Accessed January 13, 2011.
Pancreatic cancer: surgery. American Cancer Society website. Available at: http://www.cancer.org/Cancer/PancreaticCancer/DetailedGuide/pancreatic-cancer-treating-surgery. Updated October 2010. Accessed January 13, 2011.
Recovering from a Whipple’s operation. CancerHelp UK website. Available at: http://www.cancerhelp.org.uk/about-cancer/cancer-questions/recovering-from-a-whipples-operation#diet. Updated December 2009. Accessed January 13, 2011.
What you need to know about cancer of the pancreas. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/wyntk/pancreas.pdf. Updated May 2010. Accessed January 13, 2011.
6/6/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: 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.e8.
Last reviewed February 2011 by Rosalyn Carson-DeWitt, MD
Last updated Updated: 6/6/2011
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2011 EBSCO Publishing All rights reserved.