Pancreatoduodenectomy

The Whipple procedure is the surgical removal of the head of the pancreas, the duodenum (part of the small intestine), part of the common bile duct, the gallbladder and sometimes a portion of the stomach. This booklet will explain:

  • Why you may need to have a Whipple procedure
  • How the surgery is performed
  • What to expect before and after the operation

WHY DO I NEED TO HAVE A WHIPPLE PROCEDURE DONE?

The Whipple procedure is done when a patient has a suspected or diagnosed cancer of the head of the pancreas, ampulla, duodenum, or distal bile duct.

IS THERE ANY REASON TO AVOID OR DELAY HAVING THIS SURGERY?

Some patients with diagnosed cancer are eligible to have radiation treatment and chemotherapy before surgery to try to reduce the size of the tumor. Other patients may have a tumor that is too large to surgically remove, or it is spread to other areas of the body. In this case, chemotherapy and/or radiation therapy are the best forms of treatment available. It is possible that these patients may be able to participate in a clinical trial, testing new types and combinations of treatment.

HOW DO I DECIDE IF I SHOULD HAVE A WHIPPLE PROCEDURE?

The Whipple procedure is a difficult surgery with many potential complications. The goal is to only operate on patients who may have removable tumors. Your doctor will determine this based on a number of different tests and procedures. He or she may not be able to determine if your tumor is removable until the time of operation.

Ask your surgeon:

  • What will happen if I don't have the Whipple procedure?
  • What are the risks of the Whipple procedure in my particular case?
  • What are the survival rates of people having the surgery compared to people who don't have the surgery?

WHAT NEEDS TO BE DONE TO PREPARE FOR SURGERY?

Before your operation, you will be asked to sign an "informed consent" to the operation. This form lets you know any risks or possible complications that can be caused by surgical procedures in general.

You will need to have blood tests, a chest x-ray, and possibly an EKG before surgery. In some cases it is necessary to have you see a cardiologist for further evaluation for surgery.

The day before your surgery, you may need to do a "bowel prep". This consists of eating no solid foods, drinking only clear liquids, and taking medication(s) that will cause your body to eliminate any contents in your digestive tract. If necessary, your doctor will give you specific instructions on this and prescriptions for the medication(s) needed.

You will be admitted to the hospital on the day of your surgery. Under certain circumstances, your doctor may need to admit you to the hospital the day before surgery.

HOW IS THE SURGERY PERFORMED?

The surgeon may begin the surgery using a laparoscope to determine if there is spread of cancer to other areas in the abdominal cavity. When the surgeon uses a laparoscope, they make small incisions, about 1-2 centimeters long, to look inside with a tube that has a camera at the end. The picture is projected on a television screen for the surgeon to see. If cancer is not visible in other areas, the surgeon will then make a large incision in the abdomen. He or she will remove the "head" of the pancreas, the duodenum, a portion of the bile duct, the gallbladder and sometimes a portion of the stomach.

After this is complete, the remaining portions of the pancreas, bile duct, small intestine, and stomach will be "re-connected". At the end of the surgery, a tube will be inserted to drain abdominal fluids. There will also be a tube in the stomach to help prevent post-operative vomiting. An additional tube may be placed in the small intestine for feeding while recovering from surgery.

The operation takes from 5-8 hours to perform. You will be in the hospital at least seven days.

WHAT WILL MY RECOVERY BE LIKE?

After the operation, you will be in recovery for two to four hours. After recovery, you will then be admitted to the intensive care unit. After surgery, you will require close monitoring and care by the nursing staff. This includes:

  • Vital signs (temperature, pulse, respiratory rate, and blood pressure) every 15-60 minutes, and tapered gradually throughout your hospital stay.
  • Urine output is monitored closely with a foley catheter.
  • A nasogastric (NG) tube is in place and will suction any stomach contents to prevent vomiting.
  • One or two intravenous (IV) catheters will be in place to administer IV fluids and medications.
  • Pain medications may be given intravenously or through an epidural catheter placed in your back at first. The epidural decreases your sensation of pain in your abdomen, without having systemic effects, such as slowing mental function. Later, pain medications can be given by mouth.
  • Antibiotics may be given for several days.
  • Measures will be taken to help prevent the formation of blood clots in your legs.
  • Deep breathing is encouraged to help prevent post-operative pneumonia. You may also be provided with an incentive spirometer and instructed on how and when to use it.
  • Laboratory tests will be obtained on a regular basis. This will be done less frequently as you recover from surgery.
  • A chest x-ray and other radiology exams may be performed as needed.
  • You may receive nutrition intravenously or through a jejunostomy tube (J-tube) that was inserted into your small intestine during surgery.

WHAT ARE THE POSSIBLE COMPLICATIONS?

The mortality rate (risk of death) for pancreaticoduodenectomy is less than 10%. The postoperative morbidity (difficulties) is as high as 50%. The possible complications include:

  1. Bleeding
  2. Infection
  3. Abscess inside the abdomen
  4. Fistulas (leaks) from the re-connection of the pancreas, bile duct, stomach, and small intestine.
  5. Inflammation of the pancreas.
  6. Other organ failure such as heart, lung, kidney, and liver.

WHAT ARE THE LONG-TERM EFFECTS?

You may have a decreased appetite. Your body will not be able to digest fats as effectively, so you will need to take medication every time you eat. There is a 15-25% chance that you will become diabetic and require insulin injections.

WHAT HAPPENS WHEN I GO HOME FROM THE HOSPITAL?

  • You will usually see the surgeon in the office 3-10 days after discharge from the hospital.
  • You will not be allowed to do any heavy lifting or straining for 6-8 weeks.
  • You may be able to return to work 2-3 months after surgery.
  • If your tumor is cancerous, you may need to see a medical oncologist and radiation oncologist to determine if further treatment is needed.
  • You should take medications as prescribed.
  • Call your doctor if you have
    • a temperature greater than 100.7
    • persistent nausea or vomiting
    • increased pain levels
    • drainage from your incision
    •  any other questions or concerns

My Surgeon's Name______________________________
My Nurse's Name________________________________
My Nurse's phone number _________________________
After hour's phone number _________________________ (urgent call's only)

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