A Whipple procedure — also known as a pancreaticoduodenectomy — is a complex operation to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct.
The Whipple procedure is used to treat tumors and other disorders of the pancreas, intestine and bile duct. It is the most often used surgery to treat pancreatic cancer that's confined to the head of the pancreas. After performing the Whipple procedure, your surgeon reconnects the remaining organs to allow you to digest food normally after surgery.
The Whipple procedure is a difficult and demanding operation and can have serious risks. However, this surgery is often lifesaving, particularly for people with cancer.
Depending on your situation, your doctor may talk with you about other pancreatic operations. Seek a second opinion from a specialized surgeon if needed. Options include:
- Surgery for tumors or disorders in the body and tail of the pancreas. Surgery to remove the left side (body and tail) of the pancreas is called a distal pancreatectomy. With this procedure, your surgeon may also need to remove your spleen.
- Surgery to remove the entire pancreas. This is called total pancreatectomy. You can live relatively normally without a pancreas but will need lifelong insulin and enzyme replacement.
- Surgery for tumors affecting nearby blood vessels. Many people are not considered eligible for the Whipple procedure or other pancreatic surgeries if their tumors involve nearby blood vessels. At a very few medical centers in the United States, highly specialized and experienced surgeons will safely perform these operations in select patients. The procedures involve also removing and reconstructing parts of blood vessels.
Why it's done
A Whipple procedure may be a treatment option for people whose pancreas, duodenum or bile duct is affected by cancer or other disorder. The pancreas is a vital organ that lies in the upper abdomen, behind your stomach. It works closely with the liver and ducts that carry bile. The pancreas releases (secretes) enzymes that help you digest food, especially fats and protein. The pancreas also secretes hormones that help manage your blood sugar.
Your doctor may recommend you have a Whipple procedure to treat:
- Pancreatic cancer
- Pancreatic cysts
- Pancreatic tumors
- Ampullary cancer
- Bile duct cancer
- Neuroendocrine tumors
- Small bowel cancer
- Trauma to the pancreas or small intestine
- Other tumors or disorders involving the pancreas, duodenum or bile ducts
The goal of doing a Whipple procedure for cancer is to remove the tumor and prevent it from growing and spreading to other organs. This is the only treatment that can lead to prolonged survival and cure for most of these tumors.
The Whipple procedure is a technically difficult operation, often involving open surgery. It carries risks both during and after surgery. These may include:
- Bleeding at the surgical areas
- Infection of the incision area or inside your abdomen
- Delayed emptying of the stomach, which may make it difficult to eat or to keep food down temporarily
- Leakage from the pancreas or bile duct connection
- Diabetes, temporary or permanent
Extensive research shows that surgeries result in fewer complications when done by highly experienced surgeons at centers that do many of these operations. Don't hesitate to ask about your surgeon's and hospital's experience with Whipple procedures and other pancreatic operations. If you have any doubts, get a second opinion.
How you prepare
Your surgeon will review several factors to evaluate which approach to your surgery is best in your situation. He or she will also assess your condition and ensure that you are healthy enough for a complex operation. You may require some additional medical tests and optimization of some of your health conditions before proceeding to surgery.
A Whipple procedure may be done in various ways:
- Open surgery. During an open procedure, your surgeon makes an incision in your abdomen in order to access your pancreas. This is the most common approach and the most studied.
- Laparoscopic surgery. During laparoscopic surgery, the surgeon makes several smaller 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. Laparoscopic surgery is a type of minimally invasive surgery.
- Robotic surgery. Robotic surgery is a type of minimally invasive surgery 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 large to be effective.
Minimally invasive surgery offers some benefits, such as lower blood loss and a quicker recovery in those without complications. But it also takes longer, which can be hard on the body. Sometimes a procedure may begin with minimally invasive surgery, but complications or technical difficulty require the surgeon to make an open incision to finish the operation.
Before your Whipple operation, your surgeon will explain to you what to expect before, during and after surgery, including potential risks. Your treatment team will talk with you and your family about how your surgery will affect your quality of life. Sometimes the Whipple procedure or other pancreas operations being performed for cancer is preceded or followed by chemotherapy, radiation therapy or both. Talk with your doctor about concerns you may have about your surgery and various other treatment options either before or after your operation.
Before being admitted to the hospital, talk to your family or friends about your hospital stay and discuss any help you may need from them when you return home. You will need someone's help for the first couple of weeks after discharge from the hospital. Your doctor and treatment team may give you instructions to follow during your recovery when you return home.
Food and medications
Talk to your doctor about:
- When you can take your regular medications and whether you can take them either the night before or the morning of surgery
- When you need to stop eating or drinking the night before the surgery
- Allergies or reactions you have had to medications
- Any history of difficulty or severe nausea with anesthesia
What you can expect
Before the procedure
The morning of surgery, you'll check into the admission desk and register. Nurses and staff members will confirm your name, date of birth, procedure and surgeon. You will then need to change into a surgical gown in preparation for surgery.
Before your surgery, an intravenous (IV) line is put into a vein, usually in your arm. This is used to inject fluid and medication into your veins as needed. You may also receive some medication to help you relax if you are nervous.
You may also undergo placement of an epidural catheter or a spinal injection in addition to local nerve blocks to the abdominal wall. These procedures allow you to recover with minimal pain and discomfort after surgery and help to decrease the amount of narcotic pain medication you will need.
During the procedure
A surgical team works together to enable you to have a safe and effective surgery. The team is made up of pancreatic surgeons, specialized surgical nurses, anesthesiologists and anesthetists — doctors and nurses trained in giving medication that causes you to sleep during surgery — and others.
After you are asleep, additional intravenous lines may be placed with other monitoring devices, depending on the complexity of the operation and your overall health conditions. Another tube, called a urinary catheter, will be inserted into your bladder. This drains urine during and after surgery. It is typically removed one or two days after surgery.
Surgery may take four to 12 hours, depending on which approach is used and the complexity of the operation. Whipple surgery is done using general anesthesia, so you'll be asleep and unaware during the operation.
The surgeon makes an incision in your abdomen to access your internal organs. The location and size of your incision varies according to your surgeon's approach and your particular situation. For a Whipple procedure, the head of the pancreas, the beginning of the small intestine (duodenum), the gallbladder and the bile duct are removed.
In certain situations, the Whipple procedure may also involve removing a portion of the stomach or the nearby lymph nodes. Other types of pancreatic operations also may be performed, depending on your situation.
Your surgeon then reconnects the remaining parts of your pancreas, stomach and intestines to allow you to digest food normally.
After the procedure
After your Whipple procedure, you can expect to:
- Stay in the general surgical unit. Most people will go directly to a general surgical nursing floor after surgery to recover. Nursing staff and the entire surgical team will be monitoring your progress several times a day and watching for any signs of infection or complications. Your diet will be slowly advanced as tolerated. Most people will be walking immediately after the operation. Expect to spend at least a week in the hospital, depending on your overall recovery.
- Stay in the intensive care unit (ICU) for a few days. If you have certain medical conditions or a complex case, you may be admitted to the ICU after surgery. ICU doctors and nurses will monitor your condition continuously to watch for signs of complications. They'll give you fluids, nutrition and medications through intravenous (IV) lines. Other tubes will drain urine from your bladder and drain fluid and blood from the surgical area.
After discharge from the hospital, most people can return directly home to continue recovery. Some people are asked to stay nearby for several days for monitoring and follow-up visits. Older adults and people with significant health concerns may require a temporary stay in a skilled rehabilitation facility. Talk to your surgeon and team if you are concerned about your home recovery.
Most people are able to return to their usual activities four to six weeks after surgery. How long it takes you to recover may depend on your physical condition before your surgery and the complexity of your operation.
Your chances of long-term survival after a Whipple procedure depend on your particular situation. For most tumors and cancers of the pancreas, the Whipple procedure is the only known cure.
Talk to your treatment team, family and friends if you feel stressed, worried or depressed. It may help to discuss how you're feeling. You may want to consider joining a support group of people who have experienced a Whipple procedure or talking with a professional counselor.