Patient education: Whipple procedure (The Basics)

What is a Whipple procedure? — 

This is surgery to remove part of the pancreas. It is also called a "pancreaticoduodenectomy." During this surgery, the doctor removes the gallbladder and bile duct, part of the stomach, part of the pancreas, and part of the small intestine (figure 1). If they do not remove part of the stomach, it is called a "modified Whipple" procedure (figure 2).

A Whipple procedure is done when there is a problem, such as cancer, in the "head" of the pancreas. This is the part that is near where the pancreas empties into the small intestine.

When a Whipple procedure is done for cancer, some people will get radiation or chemotherapy before surgery. They can help shrink a tumor and make the surgery easier to do.

This surgery can be done in 2 ways:

●Open surgery – During an open surgery, the doctor makes a cut, or "incision," in the skin. This lets them see directly inside the body when they do the surgery.

●Minimally invasive surgery – "Minimally invasive" surgery lets the doctor make smaller incisions in the skin. They insert long, thin tools through the incisions. One of the tools has a camera (called a "laparoscope") on the end, which sends pictures to a TV screen. The doctor can look at the screen to see inside the body. Then, they use the long tools to do the surgery. They can control the tools directly, or with the help of a robot (this is called "robot-assisted" surgery). In some cases, the doctor will have to switch from a minimally invasive approach to an open surgery.

You might be able to return to normal activities sooner if you had minimally invasive surgery than if you had an open surgery.

How do I prepare for a Whipple procedure? — 

The doctor or nurse will tell you if you need to do anything special to prepare. Before your procedure, your doctor will do an exam. They might send you to get tests, such as:

●Lab tests

●Imaging tests – These might include an ultrasound, CT scan, MRI scan, or "endoscopic retrograde cholangiopancreatography" ("ERCP"). Imaging tests create pictures of the inside of the body and can show abnormal growths.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before surgery. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●Lowering the risk of infection – In some cases, you might need to trim (not shave) your body hair before your procedure. You might also need to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during a Whipple procedure? — 

When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia include:

•Regional – This type of anesthesia blocks pain in 1 area of your body, such as an arm, a leg, or the lower half of your body. If you get regional anesthesia, you might be awake. Or you might get medicines to make you relax and feel sleepy, called "sedatives."

•General – This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●You might get medicines to help control pain after the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will remove your gallbladder and bile duct, part of your pancreas, and part of your small intestine. Sometimes, they will also remove part of your stomach or nearby lymph nodes.

●They will reconnect your pancreas, bile duct, and stomach to the rest of your small intestine.

●They might also put in 1 or more drains to remove fluid from your abdomen.

●They will close your incisions and cover them with clean bandages.

What happens after a Whipple procedure? — 

After your procedure, you will be taken to a recovery room or intensive care unit ("ICU"). The staff will watch you closely as your anesthesia wears off. Most people stay in the hospital for about a week.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●You might also have:

•A tube in your nose to help drain fluid from your stomach

•A tube in your bladder to drain urine

The doctors will often remove these when there is only a little drainage.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine if needed to help with pain. You might need other medicines, too.

●When you are ready to eat, you will start with clear liquids. Then, you will slowly begin to add other foods as you are able.

What are the risks of a Whipple procedure? — 

Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Delayed emptying of the stomach

●Trouble with digestion

●Leaking from where the intestine was reconnected

●Problems with blood sugar

●Bleeding

●Infection

What else should I know? — 

Before you go home from the hospital, make sure that you know what problems to look out for and when you should call the doctor. Make sure that you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

Patient education: Pancreatic cancer (The Basics)
Patient education: Endoscopic retrograde cholangiopancreatography (ERCP) (The Basics)

Patient education: Pancreatic cancer (Beyond the Basics)
Patient education: ERCP (endoscopic retrograde cholangiopancreatography) (Beyond the Basics)