A Whipple procedure is also known as a pancreaticoduodenectomy. It is a highly complex procedure with a very demanding operation. During this procedure, a surgeon removes the head or the top of the pancreas, the duodenum (the top part of the intestine) and the bile duct and gallbladder. Though highly difficult, it is one of the most common treatments administered for pancreatic cancer, especially when the cancer is restricted to the top part of the pancreas. In this article, we will explore everything there is to know about the Whipple procedure, as well as a few similar and alternate treatment techniques.
Why Do Doctors Recommend the Whipple Procedure?
Most commonly, the Whipple procedure is recommended as a form of cancer treatment. However, it can also be used to treat a variety of other conditions such as:
- Bile duct cancer
- Pancreatic cysts
- Pancreatic tumours
- Ampullary cancer
- Small bowel cancer
- Neuroendocrine tumours
- Trauma to the pancreas
- Trauma to the duodenum
- Other conditions that impact the functioning of the pancreas, small intestine and bile duct.
Types of Whipple Procedures:
Whipple procedure types are categorised on the basis of how the procedure is carried out. There are three main variants that a doctor may choose from, depending on the condition of the patient:
- Open surgery: During an open surgery, the surgeon makes an incision in the abdomen to remove the organs. The steps will be discussed later in the article.
- Laparoscopic surgery: During this, the surgeon makes small incisions in different areas of the abdomen. He/she then uses special instruments in order to perform the procedure.
- Robotic surgery: During this surgery, surgical tools are attached to a special machine, and the surgeon uses to a controller to move the instruments around and perform the surgery. This is a minimally invasive procedure.
Whipple Procedure: What to Expect
Before the Procedure:
A nurse will insert an IV into the patient’s veins to supply the body with the required fluids and medicines. Nurses may also administer certain medicines that can help patients relax, if they are extremely nervous about the procedure. Some patients may also receive an additional epidural catheter which can help block the nerves of the abdominal wall. This can help by making the recovery procedure more painless.
During the Procedure:
Once the anaesthesia is administered, the patient is taken to the OR (sometimes the anaesthesia is administered in the OR, in which case patients are wheeled there first). A specialist inserts a urinary catheter to drain urine during and after the surgery. Typically, this is removed after one or two days, as urine output needs to be monitored in post-op patients. This is because the frequency and colour of the urine can indicate an infection.
Surgeons may take anywhere between 4 hours to 12 hours to perform the surgery. This is because sometimes, the surgeons may have to remove additional organs like part of the stomach or lymph nodes that are located near the pancreas. Thus, the complexity of the surgery determines the total time. During the procedure, anaesthesiologists and other surgical staff members monitor the patient’s vital signs and make sure that everything is okay.
The surgeon begins the surgery by making an incision in the abdomen. This exposes the organs underneath. Then, the surgeon removes the head of the pancreas, the duodenum, and the bile duct. The surgeon also removes the gallbladder. Once the organs are removed, the surgeon will connect the digestive tract so that digestive functions can occur normally.
After the Procedure:
Once the procedure is over, patients are directly transferred to the general floor in order to recover. Surgeons and nurses will continue to closely monitor the progress of the patient. Over time, the patient’s diet will also be advanced on seeing the way the body tolerates different foods. Patients generally spend a minimum of 7 days in the recovery floor before being discharged.
If there are complications during the procedure, the patient may be transferred to the ICU for observation, instead of the general floor.
It takes anywhere between 4 weeks to 6 weeks for patients to resume their regular life.
Risks Associated with the Whipple Procedure:
Some of the Whipple procedure risks that can occur during or after the surgery include:
- Bleeding at the different surgical sites
- Internal infection in the abdomen
- Infection that occurs at the incision site
- Leakage from pancreas
- Leakage from bile duct connections
- Temporary or permanent diabetes
- Delayed emptying of the stomach, which can lead to difficulties while eating or keeping the food down.
The Whipple procedure is the main cure for cancer of the pancreas. With proper care, patients can expect to live a long and full life.