What is a Whipple procedure?
A Whipple procedure is complex surgery involving the pancreas and other nearby parts of the digestive tract. The pancreas sits behind the stomach. It makes enzymes that aid in the digestion of fats and proteins. It releases these enzymes into the small intestine via the common bile duct, which also transports bile from the liver. The pancreas also makes hormones, including insulin and glucagon, to help your body control blood sugar levels
The Whipple procedure removes the head of the pancreas, which is the thick end that connects to the small intestine. Typically, it also removes most of the duodenum, which is the first part of the small intestine, the gallbladder, part of the bile duct, and some lymph nodes. Sometimes, surgeons need to remove more of the pancreas, the entire duodenum, and part of the stomach.
The procedure is named after Dr. Allan Whipple who perfected it in the 1930s. The technical name for it is pancreaticoduodenectomy. It treats tumors and other problems with the pancreas.
Why is a Whipple procedure performed?
The main reason doctors use a Whipple procedure is to treat a cancerous tumor in the head of the pancreas. In fact, it is the most common surgery to treat this type of pancreatic cancer. Doctors may recommend it if the tumor hasn’t spread—or metastasized—and they can remove it entirely. It offers a potentially curative treatment if this is the case. About 20% of people with pancreatic cancer may be eligible for this surgery. Cancers in the tail of the pancreas, which is the thinner end, involve a different procedure called a distal pancreatectomy.
Other reasons doctors may recommend a Whipple procedure include:
- Cancer of the bile duct or duodenum
- Noncancerous—or benign—pancreatic cysts and tumors
- Trauma involving the pancreas or duodenum
Talk with your doctor about all risks and benefits of the procedure before deciding to have a Whipple procedure.
Who performs a Whipple procedure?
Surgeons who perform a Whipple procedure are typically called surgical oncologists or hepatobiliary and pancreatic surgeons. A surgical oncologist specializes in treating cancer using surgery. These doctors may further specialize in hepatobiliary and pancreatic surgery. This specialty focuses on treating cancers of the liver and pancreatic system.
With a Whipple procedure, the experience of the surgeon and hospital is vital. The procedure itself is very complex and the risk of complications is high. Data consistently show that highly experienced doctors at highly experienced cancer centers have the best outcomes. Look for both a hospital and a doctor who perform more than 15 Whipple procedures per year. This experience can reduce fatal surgical complications from 15% to less than 5%.
How is a Whipple procedure performed?
A Whipple procedure should take place in a hospital with extensive experience with it. The surgery can be either a traditional open surgery or a minimally invasive procedure. The most common approach is open surgery with a large incision in the abdomen. However, some doctors and hospitals are able to do the surgery using laparoscopic and robotic techniques. When minimally invasive approaches are an option, they generally entail a faster recovery time, less pain, and a lower risk of some complications, such as infection.
General anesthesia is necessary for a Whipple procedure. General anesthesia uses a combination of IV (intravenous) medications and gases to put you in a deep sleep.
A Whipple procedure is complex and takes anywhere from 4 to 12 hours to complete. Whipple procedure steps generally follow this order:
- The surgeon makes an incision in the abdomen and removes the head of the pancreas, including the tumor.
- The surgeon removes most of the duodenum, the gallbladder, some of the bile duct, nearby lymph nodes, and possibly part of the stomach.
- The surgeon connects the remaining part of the pancreas to the cut end of the small intestine. The remaining bile duct is also reattached to the small intestine. This allows digestion to take place as normally as possible.
- The surgeon creates a new connection for the stomach and small intestine so food can pass normally through the digestive tract.
Sometimes, extensive imaging before surgery fails to find cancerous spread. If surgeons discover the cancer has spread after starting the procedure, they will not be able to complete the surgery.
What to expect the day of your Whipple procedure
In general, this is what happens the day of your surgery:
- Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. You will have blankets for modesty and warmth.
- Talk with a preoperative nurse. The nurse will perform an exam, place an IV line, and ensure that everything is in order. The nurse can also answer questions and will make sure you understand what to expect.
- Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
- Your team will take you to the operating room and the anesthesiologist or nurse anesthetist will start your anesthesia.
- After you are asleep, the team will connect more tubes, lines, and monitoring equipment. This will include a tube in your windpipe to protect and control breathing during general anesthesia and a urinary catheter to drain your bladder. The breathing tube will come out before you wake up. The urinary catheter typically stays in place for a day or two.
- The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of a Whipple procedure?
Any surgery has risks. However, a Whipple procedure carries a higher risk of complications than most surgeries. Up to 40% of people have some type of complication afterwards. It is a highly complex procedure that can also result in life-threatening complications. The Whipple procedure survival rate is high with an experienced surgeon. Fewer than 5% of people have fatal surgical complications when this is the case.
General risks of surgery
The general risks of surgery include:
- Anesthesia reaction, such as an allergic reaction and problems with breathing
- Bleeding, which can lead to shock
- Blood clot, in particular a deep vein thrombosis (DVT) that develops in the leg or pelvis. A DVT can travel to your lungs and cause a pulmonary embolism.
- Infection of the incision
Potential complications of a Whipple procedure
Most Whipple procedures are successful, but potential complications include:
- Changes in bowel habits
- Diabetes, which may be temporary or permanent
- Difficulty digesting certain foods, which may require medicines to help digestion
- Infection in the abdomen
- Leaking from the new connections in the gut
- Digestive malabsorption of vital nutrients
- Weight loss
Reducing your risk of complications
The main way to reduce the risk of complications from a Whipple procedure is to work with a highly experienced surgeon. You can do your part to reduce your risk of certain complications by:
- Following activity, dietary and lifestyle restrictions and recommendations before your surgery and during recovery
- Informing your doctor if you are nursing or if there is any possibility of pregnancy
- Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
- Taking your medications exactly as directed
- Telling all members of your care team if you have allergies
How do I prepare for a Whipple procedure?
Your surgeon will give you specific instructions about preparing for your Whipple procedure. This generally includes:
- Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
- Getting any preoperative testing your doctor orders. For a Whipple procedure, this may involve imaging exams of your abdomen.
- Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
- Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
- Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.
Questions to ask your doctor
It’s important to get all your questions answered before having a Whipple procedure. Here is a list of questions you may want to ask:
- Can a Whipple procedure remove my tumor? Why or why not?
- How extensive does the procedure need to be?
- Do I need other treatments before the Whipple procedure?
- How many Whipple procedures do you perform in a year?
- How many Whipple procedure patients does your hospital care for in a year?
- What is your complication rate? What complications do you see most often?
- Are you planning to do open surgery or a minimally invasive approach?
- How long will the procedure take and how long will I be in the hospital?
- How will you manage my pain?
- How long does it usually take to fully recover?
- What are the possible long-term effects?
- What happens if you start the procedure and find out the cancer is more extensive than you thought?
- When and how should I contact you once I go home? Ask for numbers to call during and after regular hours.
What can I expect after a Whipple procedure?
Knowing what to expect makes it easier to plan and prepare for a successful recovery.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
The hospital stay after a Whipple procedure is usually quite long. The goal of the hospital recovery is to monitor for complications and get you eating and drinking. This involves transitioning off IV nutrition or a feeding tube and slowly advancing your diet. A normal stay is about 7 to 10 days and some people require care in an ICU (intensive care unit) before going to a general unit.
After discharge, some people need to go to a rehabilitation center before returning home. Once you are home, recovery takes about six weeks. You will likely be able to return to normal activities at that time. However, some people require weeks of tube feedings or IV nutrition if delayed stomach emptying remains a problem. It can take a full year before you feel like yourself again.
Will I feel pain?
You will have pain and discomfort after a Whipple procedure. Controlling your pain is important for your healing and recovery. If your pain management plan is not controlling your pain, let your hospital staff know. If you are home, call your doctor if your pain worsens or changes. It may be a sign of a complication.
When should I call my doctor?
If you have questions between follow-up appointments after a Whipple procedure, call your doctor’s office during normal business hours. Call doctor right away or seek immediate medical care if you have:
- Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
- Change in alertness, such as passing out, unresponsiveness, or confusion
- Fever or signs of infection in your incision, such as drainage, pus, redness or swelling
- Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
- No bowel movements for three days or bowel movements that are frequent and oily
- Pain that is not controlled by your pain medication
How might a Whipple procedure affect my everyday life?
Depending on your situation, a Whipple procedure may be curative. However, long-term effects are common. This may include permanent dietary changes to manage problems like gas and diarrhea. Some people also need to take medicines containing pancreatic enzymes to aid digestion. It is possible to develop diabetes because of the procedure as well.