What is the Whipple Procedure?
Pancreatoduodenectomy is commonly referred to as the Whipple procedure and is named after Allan Whipple, MD, a physician who perfected the surgery in the 1930s. During the Whipple procedure, the surgeon removes cancerous parts of the pancreas, duodenum, common bile duct, and if required, portions of the stomach.
The Whipple procedure is performed to treat the following conditions:
THE PROCEDURE
The Whipple Procedure, or Pancreaticoduodenectomy, is the most commonly performed surgery to remove tumors in the pancreas.
The laparoscopic Whipple procedure is performed through small incisions in the abdominal wall however, conventional surgeries however require a longer incision and wider opening of the abdomen. A laparoscope, a long thin tube with a lighted camera at its tip, is inserted through one incision. The surgeon operates using specially designed surgical instruments placed through the remaining incisions, guided by the laparoscope images shown on a monitor in the operating room.
In a standard Whipple procedure, the surgeon removes the head of the pancreas, the gallbladder, part of the duodenum which is the uppermost portion of the small intestine, a small portion of the stomach called the pylorus, and the lymph nodes near the head of the pancreas.
The surgeon then reconnects the remaining pancreas and digestive organs so that pancreatic digestive enzymes, bile, and stomach contents will flow into the small intestine during digestion.
In another type of Whipple procedure known as pylorus preserving Whipple, the bottom portion of the stomach, or pylorus, is not removed.
In both cases, the surgery usually lasts between 5-8 hours.
The Laparoscopic Whipple Procedure Advantages
Results are different for each procedure and each patient. Some common advantages of minimally invasive Whipple Procedure Advantages are:
Possible Complications
After a Whipple procedure, the most common complication is delayed gastric emptying, a condition in which the stomach takes too long to empty its contents.
Usually, after 7-10 days the stomach begins to work properly. If delayed gastric emptying persists, supplemental feedings by a feeding tube may be started. The condition usually lasts for another 7-10 days, but could last as long as a few weeks.
The most serious potential complication is abdominal infection due to leakage where the pancreas has been connected to the intestine. This occurs in approximately 10% of patients and is usually managed by a combination of draining tubes, antibiotics, and supplemental tube feedings.
Patients who have undergone the Whipple procedure may experience long-term effects including digestive difficulties and weight loss. Patients may also experience malabsorption of foods, due to the diminished pancreas.
Diabetes can develop if too many insulin-producing cells are removed from the pancreas. However, patients who have normal blood sugar before surgery are unlikely to develop diabetes, and those who recently developed diabetes before surgery are even likely to improve.
PREPARATION FOR SURGERY
Before traveling to Cyprus, as part of your surgery preparation you will complete a detailed specific questionnaire, which will allow our doctors to determine your eligibility for the Whipple procedure.
Ten days prior to your arrival in Cyprus, you will receive all the necessary pre operative instructions, to prepare yourself both physically and mentally for your chosen procedure.
Before your departure your records will be reviewed thoroughly by our surgeon. This includes X-rays and a complete medical and surgical history as well as your specific issues. In addition, you may be asked to consult with a physical therapist to discuss recovery, hip rehabilitation and important precautions you must take postoperatively. The physical therapist may even give you exercises you can begin prior to your surgery in order to aid with recovery.
After traveling to Cyprus, a new set of X-rays will be taken as well as an in person physical examination. The surgeon and anesthetist will also go through you medical and surgical issues with you. During this visit, your surgeon will discuss your procedure and answer any questions.
Getting your house ready before your surgery
It is also important to get your house ready for after you come home from the hospital. At first it will be harder for you to move around, so arrange your furniture and household items ahead of time to make it easier for you during your rehabilitation.
Preparation for the hospital
Here are a few things to keep in mind as you pack and prepare for the hospital and recuperation:
Clothing
Getting dressed in the morning helps you feel better, so be sure to bring some comfortable clothing to the hospital:
Day before surgery
You will need to do a bowel prep to clean the stool out of your colon. Your doctor or nurse will give you more instructions based on the type of prep. You should not eat or drink anything after midnight the evening before your surgery.
Morning of surgery
Bring all your medicines in their original containers with you to the hospital. You will meet with the anesthesiologist. This doctor will talk to you about general anesthesia. This is a controlled sleep while the surgery is being done so you will not feel any pain or remember the surgery. You will have an IV or intravenous line put in to give you fluid and medicine during your surgery. When it is time for you to go to surgery, your family will be asked to wait in the waiting area. Your doctor will talk to your family there after your surgery is done.
RECOVERY AFTER SURGERY
When you wake up after your surgery, you will be in the recovery room. You will stay there until you are awake and your pain is under control. Most patients return to their room after a few hours, but some will need to stay overnight for observation.
You will receive oxygen through a thin tube called a nasal cannula that rests below your nose. A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels.
You will have an analgesia pump device to deliver pain medication into your IV or epidural space (in your spine). You will have a catheter in your bladder to monitor the amount of urine you are making. You will also have compression boots on your lower legs to help your circulation.
They will be taken off when you are able to walk , which will probably be on the 2 day after your surgery. You will also have 1 or 2 drains in your lower abdomen to drain extra liquid from the area. Most of the time, the drains are removed after a few days. If you will go home with a drain, your nurse will show you how to care for it.
Hospital discharge and home instructions
Your diet is slowly increased from ice chips to liquids to solid foods as your intestines start functioning.
Before leaving the hospital, our surgeon and staff will help you adjust to recovery in every way possible. You will receive specific instructions and precautions from your surgeon and nursing staff and they will show you safe techniques of simple activities like getting in and out of bed, bathing, going to the bathroom, managing steps at home and getting in and out of a car.
You will be able to leave the hospital when you are:
Most people are able to go home 7 days after their surgery.
LIFE AFTER SURGERY
These guidelines give you an overview of what you may expect as part of your
care after you leave the hospital. Be sure to follow your doctor’s discharge
instructions if they are different from what is listed here.
Your Activity
It is fairly common to feel weak and tired immediately after discharge from the hospital. The body needs time to recover from the stress of a major operation.
Your bowel habits
Diarrhea is a common problem during the two or three months it usually takes for the rearranged digestive tract to fully recover. If you have watery diarrhea, call your surgeon. This may be a sign of a bowel infection. Severe constipation should be avoided
Your diet
At first, patients can eat only small amounts of easily digestible food. You may need to take pancreatic enzymes either short-term or long-term to assist with digestion. Avoid foods that cause diarrhea or digestive discomfort. You will eventually be able to resume your regular diet. A dietary supplement or drink can be used.
Medications
Your medicines: Take the medicines you were taking before surgery, unless your surgeon has made a change.
Your surgeon will order a prescription pain medicine for you after surgery. As your pain lessens, over the counter pain medicines can be used. They can also be used instead of your prescription for mild pain.
Call your surgeon right away if you have:
FOLLOW-UP
Follow-up after surgery is extremely important and our surgeons at Salus are committed to providing all the post surgical care you need. In order to identify and treat any complications as they may arise, close, lifetime follow-up is essential.