Whipple Procedure

The Whipple procedure, or pancreatoduodenectomy, is a surgery in which multiple gastrointestinal structures are removed: the head of the pancreas, the gallbladder, the pylorus of the stomach, part of the duodenum (small intestine), and nearby lymph nodes.  This procedure is most commonly performed on people with cancer confined to the head of the pancreas.  It is a very intense surgery that generally lasts 5-8 hours.  

What Does The Surgery Entail?

"The Whipple Procedure, or pancreaticoduodenectomy, is the most commonly performed surgery to remove tumors in the pancreas.  In a standard Whipple procedure, the surgeon removes the head of the pancreas, the gallbladder, part of the duodenum which is the uppermost portion of the small intestine, a small portion of the stomach called the pylorus, and the lymph nodes near the head of the pancreas.  The surgeon then reconnects the remaining pancreas and digestive organs so that pancreatic digestive enzymes, bile, and stomach contents will flow into the small intestine during digestion.  In another type of Whipple procedure known as pylorus preserving Whipple, the bottom portion of the stomach, or pylorus, is not removed.  In both cases, the surgery usually lasts between 5-8 hours."    -Pancreatic Cancer Action Network

Normal anatomy of the digestive tract.

Normal anatomy of the digestive tract.

The surgeon removes the head of the pancreas, the gallbladder, part of the duodenum, the pylorus, and adjacent lymph nodes.

The surgeon removes the head of the pancreas, the gallbladder, part of the duodenum, the pylorus, and adjacent lymph nodes.

The surgeon reattaches the remaining pancreas and digestive organs.

The surgeon reattaches the remaining pancreas and digestive organs.

Common Problems After Surgery

The Whipple surgery is very intense for the patient and includes thorough monitoring after coming out of surgery.  These patients come to the ICU post-op and usually have a breathing tube, a central venous catheter (to infuse multiple medications), an arterial line (to monitor blood pressure), and multiple abdominal drains.  

There are some complications that can occur in the weeks following surgery.  They include the following:

  • Delayed gastric emptying.  It usually takes about 7-10 days for the stomach to start functioning properly.  If the issue still persists, other routes of nutrition may be considered (tube feedings, TPN).
  • Infection.  If there is leakage at the attachment sites of the digestive organs, infection will occur.  This can be managed with antibiotics, drains, and possibly more trips to the OR for abdominal wash outs (cleaning the abdominal cavity).
  • Weight loss.  I'm not sure if you would consider this a "complication" per se, but it often happens after surgery. 
  • Diabetes.  Patients can develop diabetes if too many of the insulin-secreting cells of the pancreas are removed.  

Prognosis

Unfortunately, pancreatic cancer has a very poor prognosis.  Many patients do not even discover they have cancer until it has spread to surrounding organs and lymph nodes.  The overall survival rate is much higher if the cancer is found in the early stages before it has metastasized. 

"Overall, the five-year survival rate after a Whipple procedure is about 20 to 25%. Even if the procedure successfully removes the visible tumor, it’s possible that some cancer cells have already spread elsewhere in the body, where they can form new tumors and eventually cause death."   -WebMD

Other relevant articles include:

Resources

WebMD

Pancreatic Cancer Action Network

Mayo Clinic

Posted
AuthorCourtney Tracy
CategoriesPhysiology