Whipple procedure is also known as a pancreaticoduodenectomy. It encompasses several surgical procedures in one operation, which involves the removal of the gallbladder, head of the pancreas, a portion of the bile duct, a portion of the small intestine and a lower portion of the stomach.
Types of whipple surgeries
There are two types of whipple procedures
- The Standard or Classical - in this the head of the pancreas, the gallbladder, the common bile duct, the duodenum (the first portion of the small intestine), a small portion of the jejunum (the second portion of the intestine), the pyloric antrum and pylorus (the bottom third of the stomach), and lymph nodes near the head of the pancreas are all removed.
- The modified, or pylorus-preserving does not remove any part of the stomach.
Indications for whipple surgery
Some cases which can be treated with a Whipple procedure are
- Chronic pancreatitis with mass
- Pancreatic cancer: It involves the head of the pancreas
- Cholangiocarcinoma: It is a cancer of the terminal bile duct
- Cancer of the duodenum(first part of small intestine).
- Pancreatic/duodenal trauma(emergency)
Cancers of the pancreas, bile duct, or duodenum are frequently found together in ampullary area. Ampulla is a complex network of ducts that transport digestive enzymes from liver through bile duct and from pancreas through pancreatic duct into the duodenum to complete food digestion. The whipple procedure considers removal of ampulla and nearby organs, and the surgeon makes decisions based on the spread of cancer.
The risks of Whipple surgery include:
- As it is one of the major and highly complicated surgery - risk of cardio pulmonary complications in immediate post operative period.
- Bleeding - from one of the cut and sutured vessels and it could be minor or sometimes major needing intervention to stop.
- Pancreatic fistula: Pancreatic juice leaks from the area where the pancreas connects to the intestine
- Gastroparesis: A condition that affects the normal spontaneous movement of muscles in your stomach
- Infection - could be minor wound infection or major abdominal infection with sepsis
- Anastomotic leak: It occurs when bile, stomach acid, or pancreatic juices leak from the the stomach or the bile duct,from the area of joining to the jejunum.
- Dumping syndrome: Food moves too quickly from the stomach to the small intestine. It is also known as rapid gastric emptying. Dumping syndrome occurs more frequently after a whipple procedure than a modified whipple procedure
A whipple procedure can be done in various ways:
- Open surgery: An open procedure involves your surgeon making an incision in your abdomen to gain access to your pancreas. This is the most common approach.
- Laparoscopic surgery: Laparoscopic surgery involves the surgeon making several small incisions in your abdomen and inserting special instruments, including a camera that transmits video to a monitor in the operating room. The surgeon uses the monitor to direct the surgical tools as they perform the whipple procedure. Laparoscopic surgery is considered minimally invasive surgery.
- Robotic surgery: In robotic surgery, surgical tools are attached to a mechanical device (robot). The surgeon sits at a console and directs the robot with hand controls. A surgical robot can use tools in tight spaces where human hands would be ineffective.
Before the Procedure
- As it is a major and highly complicated surgery you need to be well prepared by an expert team before going for surgery.
- Before your surgery, you will have a check-up at the hospital to ensure that you are fit for the surgery and general anaesthesia. It may include blood tests, chest x ray, and physical examination and tests to check how well your heart and lungs are working.
- Try to maintain a balanced diet in the weeks before your operation and be as active as possible. This will help you speedy recover from surgery.
- You may be referred to a dietitian who is an expert in diet and nutrition. They can help you manage any digestion problems before and after surgery.
During the Procedure
- The whipple procedure is done in the hospital using general anaesthesia (you will be asleep).
- In open surgery, the surgeon makes an incision in your abdomen.
- The surgeon examines the organs and lymph nodes in the abdomen to ensure that cancer has not spread and can be removed completely. A biopsy is performed on tissue samples if required.
- The surgeon then removes the tumour, surrounding tissue, pancreas, duodenum, pylorus (lower part of the stomach), gallbladder, a portion of the common bile duct, and nearby lymph nodes.
- Following the removal of these organs, the surgeon connects the remaining healthy ends of the pancreas , bile duct and stomach to the jejunal limb allowing bile and pancreatic juices to flow into it and food from the stomach end to enter into the jejunum. Here food got mixed with these juices and got digested and absorbed into circulation.
- The incision at the surgical site is closed with sutures.
After the surgery
- You will be in the hospital for around one week following surgery.
- You will be given pain medicine to keep you comfortable.
- You will be given fluids intravenously until you can eat and drink again. You might also have a feeding tube. When you can eat and drink again, you will be given clear fluids to drink first. Solid foods and meals will be introduced gradually.
- A catheter may be used to drain urine from your bladder into a bag. You will also be fitted with drainage tubes to collect any excess fluid or blood. After a few days, these tubes will be removed.
Care at Medicover
The gastroenterology specialists at Medicover have the expertise to handle the most challenging and complex surgical cases with top-notch skill, expertise, and dexterity. They offer treatment for both benign and malignant conditions of the pancreas, liver, gallbladder, stomach and bile ducts. Our team provides comprehensive diagnosis and treatment for an array of digestive disorders. Our team of doctors are very well experienced, trained in worlds best hospitals and follow latest uptodate evidence based protocols in managing complex HPB(Hepatobiliary and pancreatic)diseases. The team of gastrointestinal doctors work with the latest technology giving personalised, cost-effective quality care to patients of all age groups. This makes Medicover one of the most trusted and best gastro hospitals for gastroenterology problems.
Frequently Asked Questions:
Whipple surgery is a complex procedure with a high risk of major complications. The surgery and management of any complications require a great deal of skill and experience.
Whipple surgery typically takes six hours to complete. Most patients are admitted to the hospital for 1 to 2 weeks following the procedure. Expert team will follow ERAS (enhanced recovery after surgery) protocol in our hospital and patient will recover early and got discharged early with less risk of complications.
Fried, greasy and fatty foods should be avoided. With an altered pancreas, these foods are difficult to digest. Instead, opt for bland foods. Post whipple procedure, it is advised to limit fat intake to not more than 40-60 grams per day.
It is a major operation, and recovery will be lengthy. If no complications arise, you should be able to resume your normal activities within 4-6 weeks.
You should be offered chemotherapy depending on stage of cancer after whipple surgery to remove cancer. This will reduce the chances of cancer returning.
Whipple procedure, the only known cure for pancreatic cancer, is typically performed on patients whose cancer has not spread beyond the pancreas. If detected early, pancreatic cancer has the potential to be curable.
Long-term complications of whipple surgery include abdominal discomfort, weight loss, digestive issues, and chronic fatigue.
Your pancreas makes insulin and controls your blood sugar. Since part of pancreas is removed during the whipple procedure, there is a chance that you may develop diabetes particularly in patients with chronic pancreatitis. Patients who have diabetes before surgery will need to adjust their diabetes medicine after surgery.
The approximate cost of whipple surgery in India is INR 2,50,000, but it can vary depending on the complexity of the disease and the city in which you are getting treated.
Local or distant site recurrence can be observed but with precise staging and multimodality treatment recurrence can be minimised or prolonged.