Whipple Procedure (Pancreaticoduodenectomy)
The Whipple procedure (pancreaticoduodenectomy) is an operation to remove pancreatic cancer in the head or neck of the pancreas – where cancer most commonly occurs in the pancreas.
The Whipple procedure is also used to treat bile duct cancer, duodenum (first part of the small intestine) cancer and benign (non-cancerous) cysts and lesions.
The Whipple procedure removes the head of the pancreas (about half), most of the duodenum, the gallbladder, the end of the common bile duct and sometimes part of the stomach. It is necessary to remove this much because the pancreas is closely tied to other organs and structures.
Your doctor reconnects the parts that are necessary to digest your food. This includes the intestine, bile duct and remaining part of the pancreas.
Why it is Done
The Whipple procedure is the only operation that can possibly cure pancreatic cancer.
If pancreatic cancer is limited to the head and neck of the pancreas and has not spread to other organs, lymph nodes or blood vessels, you may be a candidate for the Whipple procedure.
If the cancer has already spread, the Whipple procedure is not recommended.
What to Expect
The Whipple procedure is complex. It takes about six hours and requires a hospital stay of a week or two.
- Your doctor gives you instructions to follow before your surgery. The day before surgery, you may need to prepare your bowels, similar to how you prepare for a colonoscopy. This clears your digestive tract.
- You have intravenous (IV) medication to make you sleep before the operation.
- Your doctor makes a small incision (cut) in your abdomen (stomach) and inserts a thin tube (laparoscope) that contains a light and camera. The camera projects pictures onto a monitor so your doctor can see inside. This is an important first step in which your doctor checks to see if your cancer has spread.
- If the cancer does not appear to have spread, your doctor removes the laparoscope and makes a large incision for the Whipple procedure.
- Some people can have a laparoscopic (minimally invasive) Whipple procedure. This means you have six small incisions in your stomach area instead of a long incision. Your doctor inserts a long tube with a camera into one of the incisions and surgical instruments through other incisions. Your doctor looks at pictures of your insides on a monitor. Laparoscopic Whipple surgery takes four to five hours and requires a hospital stay of about four to six days. You can return to normal activities after about a month.
- After the procedure, you won't be able to eat or drink by mouth for a few days. You might not have much of an appetite. You might feel bloated. Your doctor can give you medication to help your digestive system work.
- You can expect to recover completely within two months. It can take as long as six months. You may have a decreased appetite for a long time or permanently. You need to take medication when you eat because your body has lost its ability to digest food as quickly as it should.
What the Risks Are
The Whipple procedure is a major surgery. While there is a 90 percent survival rate, as many as 50 percent of patients have complications.
Some complications can be serious:
- Leaking – The most common risk of the Whipple procedure is leaking pancreatic juices from the incision (where you were cut for surgery). If you have a leak, your doctor may place a drain through your skin to allow drainage. This remains in place for a few weeks.
- Weight loss – Most patients lose about 7 percent of their weight. You might need nutritional counseling after having the Whipple procedure.
- Diabetes – There is a 15 to 25 percent chance you will develop diabetes after having the Whipple procedure and need to have insulin injections.
Other risks include:
- An abscess (infection) in the abdomen
- Inflammation of the pancreas (pancreatitis)
- Organ failure (heart, lung, kidney or liver)