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The Whipple procedure is also called pancreaticoduodenectomy. It is surgery to remove part of the pancreas along with the duodenum. It also removes the lower part of the stomach, the gallbladder and part of the common bile duct.
A modified Whipple procedure may be done in some cases. The modified procedure doesn’t affect normal stomach function.
Why Whipple procedure is done
A Whipple procedure may be used to treat cancer in different organs, including the:
- bile duct
- small intestine, including cancer in the upper part of the duodenum or the ampulla of Vater (area where the ducts from the pancreas and liver enter the duodenum)
How Whipple procedure is done
The Whipple procedure is a major operation. It is done in the hospital under general anesthetic (you will be unconscious).
The surgeon makes an incision, or cut, in the abdomen. Then the surgeon looks at all the organs inside the abdomen to ensure the cancer can be removed completely without damaging vital structures.
If possible, the surgeon will remove the tumour along with some healthy tissue around it (called the surgical margin).The tissues removed during surgery are sent to the lab and examined by a pathologist (a doctor who specializes in the causes and nature of disease). The pathologist determines the stage, or amount, of cancer in the tissues and whether the surgical margins contain cancer cells. Based on the pathologist’s report, your doctor will decide if you need further tests, procedures, follow-up care or additional treatment.
During the Whipple procedure, the surgeon removes the following organs:
- the head of the pancreas
- the gallbladder
- the duodenum (first part of the small intestine)
- the pylorus (the lower part of the stomach that attaches to the duodenum)
- part of the common bile duct (the duct that carries bile from the liver and gallbladder to the duodenum)
- surrounding lymph nodes
After removing these organs, the surgeon attaches the remaining end of the stomach to the jejunum (called gastrojejunostomy). The rest of the common bile duct and pancreas are also attached to the jejunum so bile and pancreatic juices can flow into the jejunum. These juices help to neutralize stomach acid and lower the risk of an ulcer in the area.
Modified Whipple procedure
A modified Whipple procedure is also called pylorus-preserving pancreaticoduodenectomy. It removes all of the same organs as the Whipple procedure except for the pylorus. This surgery doesn’t remove any of the stomach, so it can still work normally. People who have the modified Whipple procedure don’t have the nutrition problems that can develop after the Whipple procedure.
After removing these organs, the surgeon attaches the remaining duodenum that is attached to the stomach to the jejunum (called duodenojejunostomy). The rest of the common bile duct and pancreas are also attached to the jejunum so bile and pancreatic juices can flow into the jejunum.
Side effects can happen any time during, immediately after or a few days or weeks after a Whipple procedure. Sometimes late side effects develop months or years after surgery. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.
The Whipple procedure carries a fairly high risk of complications. About 30%–50% of people who have this surgery will have side effects. Tell your healthcare team if you have any of the following side effects.
Pain often occurs after surgery because of trauma to the tissue. It may take time for pain to go away after surgery. Pain-relieving medicines are used to control pain. Check with your doctor if pain doesn’t go away or pain medicines don’t relieve the pain. Find out more about pain.
Infection can occur after surgery. Tubes may be placed around the infected wound to drain extra fluids. Your doctor may also prescribe antibiotics to help prevent or treat an infection. Wound infections are a temporary side effect of surgery. Find out more about infection.
Bleeding, or hemorrhage, can occur if a blood vessel is not sealed off during surgery or if you have a blood-clotting disorder. A small amount of bloody drainage may be expected after surgery. Report heavy bleeding to your doctor or healthcare team.
Leaking of bile, stomach acid or pancreatic juices can sometimes occur where the healthy ends of the stomach, duodenum or bile duct were joined to the jejunum. This is also called anastomotic leak.
Delayed gastric emptying is a condition where food stays in the stomach longer than usual. This happens when the stomach is partially paralyzed from nerve damage during surgery. Delayed gastric emptying can cause nausea, vomiting and a full feeling. It usually goes away 4–12 weeks after surgery. A feeding tube may be placed to make sure you get enough nutrition. Delayed gastric emptying is more common after a modified Whipple procedure than a Whipple procedure.
Dumping syndrome is when food moves too fast from the stomach into the small intestine. It may also be called rapid gastric emptying. Dumping syndrome can occur after a Whipple procedure but does not commonly occur after a modified Whipple. Find out more about dumping syndrome.
Nutrition problems can occur after surgery when there is a lack of digestive enzymes, pancreatic juices or bile. This can cause poor appetite, poor fat absorption, diarrhea, bloating and indigestion. You may need to take digestive enzymes.
After surgery, you will need to stay in the hospital for several days. You will be given pain medicine through a needle in a vein (intravenously) to keep you comfortable.
You will also be given fluids intravenously until you can eat and drink again. You may also have a feeding tube. When you can eat and drink again, you will first be offered clear fluids. Solid foods and meals will be introduced slowly.
You may have a catheter to drain urine from your bladder into a bag. You will also have drainage tubes to collect any extra fluid or blood. These will be removed after a few days.
After part of the pancreas is removed, the rest of the pancreas may not make enough insulin to control blood sugar. You will be given insulin injections. This is usually only needed until the pancreas recovers from surgery and starts to make insulin again.
You may also need to take digestive enzymes by mouth to help your body break down and absorb fats and proteins.
Special considerations for children
The Whipple procedure is sometimes used to treat pancreatic tumours (such as adenocarcinoma) in children.
Being prepared for a test or procedure can lower anxiety, increase cooperation and help the child develop coping skills. Parents and caregivers can help prepare children by explaining to them what will happen, including what they will see, feel and hear during the operation.
Preparation for a Whipple procedure depends on the age and experience of the child. Find out more about preparing a child for a diagnostic or treatment procedure.