The Whipple procedure (pancreatoduodenectomy) is a complex operation to remove part of the pancreas, part of the small intestine and the gallbladder.

The Whipple procedure is most often used to treat pancreatic cancer that's confined to the head of the pancreas. But it may also be used to treat tumors and other abnormalities of the pancreas, small intestine and bile duct.

After performing the Whipple procedure, surgeons work to reattach the remaining portions of the digestive system so that your body can digest the food that you eat and you can expel waste normally.

The Whipple procedure is a difficult and demanding operation for both the person undergoing surgery and the surgeon.

  • Collaboration. At Mayo Clinic, surgeons form a multidisciplinary team with gastroenterologists, oncologists, radiation oncologists, radiologists, pathologists and experts from the Pancreas Clinic to provide whole-person care for people considering the Whipple procedure.
  • Experience. Mayo Clinic surgeons have extensive experience with this complex operation. Each year, Mayo Clinic surgeons perform approximately 150 Whipple procedures.
  • Expertise. The Whipple procedure is a complex operation that requires highly skilled and extensively trained surgeons. Mayo Clinic surgeons are specially trained in order to provide you with the best care.
  • Access to the latest. Mayo Clinic is a leader in advancements of the Whipple procedure to improve recovery, quality of life and cancer outcomes. Mayo Clinic is a leader in the minimally invasive (laparoscopic) approach to the Whipple procedure and is one of the few medical centers offering the laparoscopic approach.
  • Comprehensive cancer center. Mayo Clinic Cancer Center meets strict standards for a National Cancer Institute comprehensive cancer center, which recognizes scientific excellence and a multidisciplinary approach to cancer prevention, diagnosis and treatment.

Mayo Clinic in Rochester, Minn., Mayo Clinic in Jacksonville, Fla., and Mayo Clinic in Scottsdale, Ariz., are ranked among the Best Hospitals for cancer by U.S. News & World Report.

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The Whipple procedure is often used to remove the head of the pancreas if it's affected by cancer or another abnormality.

Because some other sensitive structures are very close to the head of the pancreas, these must also be removed. This includes the beginning of the small intestine (duodenum), the bile duct and the gallbladder.

In certain situations, the Whipple procedure may also involve removing a portion of the stomach or the nearby lymph nodes.

Why it's done

The Whipple procedure may be used to treat:

At Mayo Clinic, a multidisciplinary team of experts collaborates to provide you with exactly the care you need. Your team will review your condition and explain all of your treatment options. Together you can determine which treatments best meet your needs and goals.

Types of operations

Your surgeon may approach your procedure in one of a few ways:

  • Open surgery. During an open procedure, your surgeon makes a large incision in your abdomen in order to access your pancreas.
  • Minimally invasive surgery. During a minimally invasive surgery (laparoscopic surgery), the surgeon makes several small incisions in your abdomen and inserts special instruments, including a camera that transmits video to a monitor in the operating room. The surgeon watches the monitor to guide the surgical tools in performing the Whipple procedure.
  • Robotic surgery. Robotic surgery is a type of minimally invasive operation in which the surgical tools are attached to a mechanical device (robot). The surgeon sits at a console nearby and uses hand controls to direct the robot. A surgical robot can use tools in tight spaces and around corners, where human hands may be too big to be effective.

Minimally invasive surgery offers some benefits, such as a lower risk of blood loss and a quicker recovery. But it also takes longer, which can be hard on the body.

Sometimes a procedure may begin with minimally invasive surgery, but complications or difficulty require the surgeon to make a large incision to finish the operation.

Risks

The Whipple procedure is a difficult operation to endure and it carries a risk of several complications. Choosing an experienced surgeon at a hospital that performs many Whipple procedures may reduce your risk of complications.

Complications that can occur after a Whipple procedure include:

  • Delayed gastric emptying, which may make it difficult to eat and difficult to keep food down
  • Leaking of pancreatic juices
  • Leaking of bile
  • Infection
  • Bleeding
  • Diabetes caused by removing part of the pancreas

Recovery

Expect to spend at least a week in the hospital after your Whipple procedure. You may need to stay longer if you develop complications after surgery. People who undergo minimally invasive Whipple surgery typically recover more quickly and may spend fewer days in the hospital.

As you recover, you'll slowly begin to drink clear liquids and, eventually, eat solid foods. Some people have difficulty eating enough to get the nutrition they need after surgery. In this situation, your doctor may recommend a feeding tube (enteral nutrition).

If you need to continue tube feeding at home, specialists in home enteral nutrition can teach you how to feed yourself and care for your feeding tube.

Once you return home, you'll continue to recover. Expect to be able to return to your normal activities about one month after surgery.

Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.

The Whipple procedure is performed by doctors in general surgery. These experts work closely with other specialists, such as digestive disease experts from the Pancreas Clinic, to provide whole-person care to people considering the Whipple procedure.

For appointments or more information, call the Central Appointment Office at 800-446-2279 (toll-free) 8 a.m. to 5 p.m. Mountain Standard Time, Monday through Friday or complete an online appointment request form.

The Whipple procedure is performed by doctors in general surgery. These experts work closely with other specialists, such as digestive disease experts from the Pancreas Clinic, to provide whole-person care to people considering the Whipple procedure.

For appointments or more information, call the Central Appointment Office at 904-953-0853 8 a.m. to 5 p.m. Eastern time, Monday through Friday or complete an online appointment request form.

The Whipple procedure is performed by doctors in general surgery. These experts work closely with other specialists, such as digestive disease experts from the Pancreas Clinic, to provide whole-person care to people considering the Whipple procedure.

For appointments or more information, call the Central Appointment Office at 507-538-3270 7 a.m. to 6 p.m. Central time, Monday through Friday or complete an online appointment request form.

See information on patient services at the three Mayo Clinic locations, including transportation options and lodging.

Mayo Clinic doctors and scientists are studying ways to improve care for people considering the Whipple procedure.

Mayo Clinic surgeons are also actively involved in the Gastrointestinal Cancer Program, which is dedicated to advancing scientific knowledge of cancers affecting the intestinal tract and to improving the quality of life of people affected by these diseases.

Cancer research is conducted in coordination with the Mayo Clinic Cancer Center. The Mayo Clinic Cancer Center receives funding from the National Cancer Institute and is designated as a comprehensive cancer center — recognition for an institution's scientific excellence and multidisciplinary resources focused on cancer prevention, diagnosis and treatment.

See a list of publications by Mayo Clinic authors on the Whipple procedure on PubMed, a service of the National Library of Medicine.

July 21, 2015