What is a Whipple's Procedure?
Its medical name – pancreatico-duodenectomy – is the standard treatment for pancreatic cancer where the affected section of the pancreas is removed. If necessary parts of other organs near the pancreas (such as the stomach) may need to be removed if cancer cells are present.
How should I prepare for the procedure?
Medication / supplements
You need make the surgical team aware of any medication (including alternative / complementary medicines) or diet supplements you are taking before the procedure.
Smoking
If you are a smoker, you must give up smoking 14-21 days before the procedure.
Diet
You do not need to make any changes to your diet ahead of surgery.
Staying fit and healthy
Patients undergoing this type of surgery experience better outcomes if they are fit and healthy immediately prior to the procedure, so you should continue any regular exercise as normal before the procedure. We recommend you do not take up any new exercise regime without consulting your doctor or Dr Silverman.
Avoiding wound infection
You should avoid waxing or shaving in the area where incisions are likely to be made during surgery (your doctor or surgeon will be able to tell you where the incisions will be made). This minimises the risk of wound infection.
Hygiene
There are no specific hygiene requirements before surgery, however you should have a shower or take a bath either the night before or on the morning of the surgery.
What is involved in the procedure?
A Whipple's Procedure generally takes 4-6 hours to complete under general anaesthesia. It is conducted using conventional 'open' surgery (not laparoscopic surgery).
The standard procedure involves the removal of:
- The head of the pancreas.
- The duodenum.
- The gallbladder.
- Lymph nodes around these organs.
- A segment of the common bile duct.
Depending on any spread of the cancer cells, it may in addition be necessary to remove some or all of the following:
- A section of the stomach.
- The sphincter (a type of valve) at the junction of the stomach and the small intestine.
Once the necessary tissue has been removed, the remaining pancreas, bile duct and stomach are re-connected to the small intestine.
The procedure is carried out via an incision to the abdomen immediately below the ribs. Once the tissue has been removed and the reconnections have been made, the incision is closed. In some cases, a 'drain' may need to be inserted into the abdominal cavity to enable any fluid there to drain away.
Recovery Guidance
Hospital stay
As the surgery involved in this procedure is extensive and must be conducted as conventional open surgery, there is a significant hospital stay of 10-14 days after this procedure. The first one or two days of this will be in intensive care.
Normal bodily functions such as bowel movements generally do not restart for a few days and so all nutrients will be delivered via a drip. An x-ray within the first day or two will confirm if the reconnected tissue is healing properly. If it is, you are able to resume eating and drinking normally and the drip is removed.
Returning to normal activities
It is not uncommon for full recovery from this procedure to take up to three months. While you are in recovery it is not unusual to feel very tired, to have a reduced appetite and generally feel a little low.
The recommended approach to activity during this period is to introduce light activities, such as walking and to start with short periods and distances and build these up gradually. Other more demanding activities such as driving or more physical exertion will also need to be introduced gradually - your doctor or Dr Silverman will be able to give you some guidance as to when you can resume these activities.
When to contact Dr Silverman
If you experience any of the following you must contact Dr Silverman immediately:
- Pain in the chest area.
- Pain in the upper back.
- High temperature.
- Fever.
- Feeling faint.
- Dizziness.
Risks / complications
There are risks associated with all surgical procedures (especially complex surgery such as the Whipple's procedure) such as wound infection, and risks relating to anaesthesia and bleeding during the procedure.
The risks / complications specific to Whipple's Procedure include:
- Delayed gastric emptying (this normally only lasts 7-14 days).
- Diabetes onset (caused by reduced insulin production).
- Pancreatic fistula (this causes leakage from the pancreas which may require more surgery).
- Malabsorption of nutrients (caused by reduced enzyme production).
- Weight loss (generally within the first few weeks after surgery - this should correct in time).
Dr Silverman will be able to discuss any possible risks or complications with you well ahead of the procedure.