A Whipple procedure, also known as a pancreaticoduodenectomy, is a complicated operation that involves removing the pancreas head, the first part of the small intestine (duodenum), the gallbladder, and the bile duct. 

The Whipple procedure is used to treat tumors and other pancreatic, intestine, and bile duct disorders. It is the most commonly used surgery to treat pancreatic cancer that has spread to the pancreas's head. Following the Whipple procedure, your surgeon reconnects the remaining organs, allowing you to digest food normally. 

The Whipple procedure is a difficult and demanding operation with significant risks. However, for people with cancer, this surgery is often lifesaving.

Procedures that are related 

Depending on your circumstances, your doctor may discuss other pancreatic operations with you. If necessary, seek a second opinion from a specialized surgeon. Among the options are: 

-> Surgery for tumors or disorders of the pancreas's body and tail. A distal pancreatectomy is surgery to remove the pancreas's left side (body and tail). Your surgeon may need to remove your spleen as part of this procedure. 

-> The pancreas is surgically removed. This is known as a total pancreatectomy. You can live a relatively normal life without a pancreas, but you will require insulin and enzyme replacement for the rest of your life.

-> Tumors affecting nearby blood vessels may require surgery. Many people who have tumors that involve nearby blood vessels are not considered candidates for the Whipple procedure or other pancreatic surgeries. These operations will be performed safely in a small number of medical centers in the United States by highly specialized and experienced surgeons. The procedures also include the removal and reconstruction of blood vessel segments. 

Why is it done? 

A Whipple procedure may be an option for people whose pancreas, duodenum, or bile duct have been affected by cancer or another condition. The pancreas is an important organ located in the upper abdomen, behind the stomach. It collaborates closely with the liver and bile ducts. The pancreas secretes enzymes that aid digestion, particularly of fats and proteins. The pancreas also secretes hormones that aid in blood sugar regulation. 

Your doctor may advise you to undergo a Whipple procedure to treat: 

-Cancer of the pancreas 
-Cysts of the pancreas 
-Tumors of the pancreas 
-Ampullary cancer and pancreatitis 
-Cancer of the bile duct 
-Neuroendocrine cancers 
-Cancer of the small bowel 
-Pancreas or small intestine trauma

The purpose of a Whipple procedure for cancer is to remove the tumor while also preventing it from growing and spreading to other organs. For the majority of these tumors, this is the only treatment that can lead to prolonged survival and cure.

Risks 

The Whipple procedure is a technically difficult operation that frequently requires open surgery. It is dangerous both during and after surgery. These could include: 

-Bleeding at surgical sites 
-Infection of the incision site or the inside of your abdomen 
-Delayed stomach emptying, which may make it difficult to eat or keep food down temporarily. 
-Leakage from the pancreas or the bile duct 
-Diabetes, whether temporary or chronic 

Extensive research shows that surgeries performed by highly experienced surgeons at centers that perform many of these operations result in fewer complications. Inquire about your surgeon's and hospital's experience with Whipple procedures and other pancreatic procedures. If you are unsure, seek a second opinion.

How do you prepare? 

Your surgeon will consider several factors to determine which approach to your surgery is best for you. He or she will also evaluate your condition and ensure that you are in good enough health to undergo a complex operation. Before undergoing surgery, you may need to undergo additional medical tests and have some of your health conditions optimized. 

A Whipple procedure can be performed in several ways: 

-> The procedure is open                                                                                                                                                         An open procedure involves your surgeon making an incision in your abdomen to gain access to your pancreas. This is the most common and researched approach.
 

-> Laparoscopic procedures 
Laparoscopic surgery involves the surgeon making several small incisions in your abdomen and inserting special instruments, such as a camera that transmits video to a monitor in the operating room. The surgeon uses the monitor to direct the surgical tools as they perform the Whipple procedure. Minimally invasive surgery includes laparoscopic surgery. 

-> Surgical robots 
The surgical tools in robotic surgery are attached to a mechanical device (robot). The surgeon sits at a nearby console and directs the robot with hand controls. A surgical robot can use tools in small spaces and around corners where human hands would be ineffective.

Minimally invasive surgery has some advantages, such as lower blood loss and faster recovery in those who do not have complications. However, it takes longer, which can be taxing on the body. A procedure may begin with minimally invasive surgery, but complications or technical difficulties may necessitate the surgeon making an open incision to complete the operation.

Before your Whipple procedure, your surgeon will explain what to expect before, during, and after surgery, as well as any potential risks. Your treatment team will discuss how your surgery will affect your quality of life with you and your family. Chemotherapy, radiation therapy, or both may be used before or after the Whipple procedure or other pancreas operations for cancer. Before or after your surgery, discuss any concerns you have about your surgery and other treatment options with your doctor.

Before being admitted to the hospital, discuss your hospital stay with your family or friends and any assistance you may require when you return home. You will require assistance for the first few weeks after being discharged from the hospital. When you return home, your doctor and treatment team may give you instructions to follow during your recovery.

Medication and food 

Consult your doctor about: 

-When you can resume taking your regular medications and whether you can do so the night before or the morning of surgery 
-When you must abstain from eating or drinking the night before surgery 
-Medication allergies or adverse reactions 
-Any history of anesthesia difficulties or severe nausea

What to anticipate ?

-> Prior to the procedure You'll check in at the admissions desk and register the morning of surgery. Nurses and staff will confirm your name, birth date, procedure, and surgeon. In order to undergo surgery, you will need to change into a surgical gown.

-> Throughout the procedure A surgical team collaborates to ensure that you have a safe and effective surgery. Pancreatic surgeons, specialized surgical nurses, anesthesiologists and anesthetists — doctors and nurses trained in administering medication that causes you to sleep during surgery — and others make up the team. 

Depending on the complexity of the operation and your overall health, additional intravenous lines with other monitoring devices may be placed after you have fallen asleep. A urinary catheter, which is inserted into your bladder, will be used. This is used to drain urine during and after surgery. It is usually taken out one or two days after surgery.

Depending on the approach used and the complexity of the operation, surgery can take four to twelve hours. Whipple surgery is performed under general anesthesia, so you will be asleep and unaware during the procedure. 

To gain access to your internal organs, the surgeon makes an incision in your abdomen. The size and location of your incision are determined by your surgeon's approach and your specific situation. The head of the pancreas, the beginning of the small intestine (duodenum), the gallbladder, and the bile duct are all removed during a Whipple procedure. 

In some cases, the Whipple procedure may also include the removal of a portion of the stomach or nearby lymph nodes. Depending on your situation, other types of pancreatic operations may be performed.

-> Following the procedure 

Following your Whipple procedure, you should expect to: 

- Continue to be admitted to the general surgical unit. After surgery, the majority of patients will be transferred to a general surgical nursing floor to recover. Nursing staff and the entire surgical team will check on you several times per day, looking for signs of infection or complications. Your diet will be gradually increased as tolerated. The majority of people will be able to walk immediately after the operation. Expect to be in the hospital for at least a week, depending on your overall recovery.

- Spend a few days in the intensive care unit (ICU). If you have certain medical conditions or a complicated case, you may be admitted to the intensive care unit (ICU) following surgery. ICU doctors and nurses will continuously monitor your condition for signs of complications. They will administer fluids, nutrition, and medications to you via intravenous (IV) lines. Other tubes will be used to drain urine from your bladder as well as fluid and blood from the surgical site.

Most people can go home after being discharged from the hospital to continue their recovery. Some people are asked to stay nearby for several days in order to conduct monitoring and follow-up visits. Older adults and those with serious health issues may require a brief stay in a skilled rehabilitation facility. If you are concerned about your home recovery, speak with your surgeon and team. 

Most people can resume their normal activities four to six weeks after surgery. The length of your recovery may be determined by your physical condition prior to surgery as well as the complexity of your operation.

Results 

Your chances of long-term survival following a Whipple procedure are dependent on your specific situation. The Whipple procedure is the only known cure for most pancreatic tumors and cancers. 

If you are stressed, worried, or depressed, talk to your treatment team, family, and friends. It might be beneficial to talk about how you're feeling. You might want to think about joining a Whipple procedure support group or speaking with a professional counselor.

By Recmed Medical - General Surgeons and Medical Staff