Frequently Asked Questions About the Whipple Procedure
- What is a pancreaticoduodenectomy (Whipple procedure)?
- What are the benefits of the Whipple procedure?
- What happens during the Whipple procedure?
- What happens after the surgery?
- Is the procedure right for me?
Q. What is a pancreaticoduodenectomy (Whipple procedure)?
A. A pancreaticoduodenectomy is a complex operation to treat tumors that occur within the head of the pancreas. The procedure involves removing the head of the pancreas (approximately 50 percent of the pancreas), first portion of the small intestine (duodenum), gallbladder, part of the bile duct, and occasionally a small portion of the stomach (approximately 10 percent). The operation ideally completely removes the tumor and all surrounding lymph nodes where cancer cells can metastasize or spread. Following the resection, the surgeon will reconstruct the gastrointestinal tract to allow patients to eat and digest their food.
Pancreaticodeudenectomy is commonly referred to as the Whipple procedure, named after Allan Whipple, MD, a physician who perfected the surgery in the 1930s.
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Q. What are the benefits of the Whipple procedure?
A. The major benefit of the Whipple procedure is that it is the only potential curative operation for pancreatic cancer.
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Q. What happens during the Whipple procedure?
A. If you elect to have an epidural (spinal) catheter for postoperative pain control, the epidural team will place the device while you wait in the preoperative holding area before the surgery. Although you are aware during the epidural placement, the anesthesiologist will usually give you a sedative and numbing medicine into your back. Prior to your operation, the surgeon and anesthesiologist will see you and your family in the preoperative holding area. This is an opportunity to have them answer any last minute questions.
The anesthesia team will take you to the operating room where they will put you to sleep with IV medications. The anesthesiologist will place a breathing tube so that you can get oxygen during the operation. The surgeon and his team will usually insert special IV lines, a bladder catheter and a stomach tube (through your nose) after you are asleep.
Georgann had a Whipple procedure in 2002 and is keeping healthy with regular exercise. »Read her storyThe surgeon will make a small incision in the abdomen to insert a laparoscope--a thin, lighted tube with a tiny camera that allows our surgeons to look at your abdominal cavity and internal organs. This is an essential step to evaluate any potential spread of disease that may not have been visible on your preoperative CAT scan. If no disease is seen outside of the pancreas, the surgeon will remove your tumor and reconstruct your GI tract. The surgery usually takes approximately four to eight hours to complete.
You will wake up in the operating room and be taken to the recovery unit. However, in some cases, patients with severe medical problems or intraoperative complications may need to go to the intensive care unit (ICU) after their surgery.
Pain is controlled through medications delivered through your epidural (if appropriate) or IV. Most patients will wake up with a small tube in their nose (to drain the stomach), an abdominal drain (coming out of your side), and a tube draining your bladder. These tubes are usually removed before you leave the hospital.
Most patients spend approximately seven to ten days in the hospital. If you have any complications from the surgery, we generally keep you in the hospital until the problem has been treated. In rare cases, patients may need to go to a rehabilitation center or nursing home to recover further before going home.
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What happens after the surgery?
Q. How will I feel after having the Whipple procedure?
A. Following the operation, you may experience pain from the incision and should not take any liquid or solid food by mouth for several days. The intestines usually require about one week to completely resume normal activity. However, most patients will be able to have bowel movements on their own within the first week. The stomach also might not empty very well initially after the surgery and sometimes you may feel bloated or “full.” In some cases, medication is necessary to help your digestive system work properly for the first several weeks after the operation. You may experience a decreased appetite, which sometimes takes several weeks to improve.
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Q. How will you treat my pain?
A. Your pain is initially controlled with either an epidural (spinal) catheter or a patient-controlled IV pain pump. Pain medicine specialists will see you daily. These specialists will work with your nurses and surgeons to ensure that your pain is relieved. Once you start eating, your pain medications will be taken by mouth. All patients are discharged from the hospital with a limited supply of the appropriate pain pills.
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Q. Will I need a feeding tube after surgery? Will I need a special diet?
A. Most patients will not need a feeding tube or special diet after surgery. It is generally best to eat a bland diet for the first several weeks after surgery. Nutritional supplements are sometimes helpful in improving your strength and maximizing the healing process.
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Q. What are the long-term effects of the Whipple procedure?
A. Most patients will completely recover from their operation within two months. In some cases, it may take up to six months to recover from the surgery. Most patients will need to take a daily vitamin with iron. Some patients will have temporary trouble regulating their blood sugar levels. Your doctor will determine if you need long-term medication to control your blood sugars. Some patients (i.e., overweight patients and pre-existing diabetics) may require insulin after their surgery.
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Q. When can I return to my normal activities?
A. You will get out of bed and begin walking on the first day after your operation. You should avoid heavy lifting (i.e., more than a gallon of milk) and any strenuous physical activity for at least two months after your surgery. Please check with your surgeon before driving, working or participating in sexual activity.
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Q. How often will I need checkups?
A. After leaving the hospital, most patients will return to their surgeon’s outpatient clinic within the first three weeks for a routine postoperative checkup. It is common to see your surgeon at regular intervals (i.e., every couple months) to determine if there are any postoperative problems.
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Q. What other treatment(s) will I need?
A. After your tumor has been reviewed by the pathologist, your case will be confidentially discussed by our Tumor Board. This is a comprehensive, multidisciplinary group of University of Chicago physicians, nurses, radiologists, geneticists and pathologists who have expertise in pancreatic cancer. The team will make a recommendation about the risks and benefits of additional treatment for your cancer.
The Whipple procedure helped Norma Langellier return to her active life. »Read Norma's storyAt your first postoperative appointment, your surgeon will discuss these findings with you and your family. In most cases, your surgeon will make an appointment for you to see a medical oncologist (chemotherapy doctor). Chemotherapy is often helpful at preventing your cancer from coming back. The treatment usually lasts for four to six months. In certain cases, radiation therapy is also recommended.
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Is the procedure right for me?
Q. Who is eligible for the Whipple procedure?
A. All people who have been diagnosed with pancreatic cancer are potentially eligible for this operation. You and your surgeon will decide if this treatment is right for you.
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Q. What are the risks of the Whipple procedure?
A. A pancreaticoduodenectomy is a major operation. About one-third of patients may have a complication from the operation. Complications can be major or minor and can include: bleeding, infection, leakage from your connections, clots, pneumonia and heart attacks. Your surgeon can manage most of these problems without having to perform another operation. Having a complication will likely delay your discharge from the hospital and may alter your recovery. Nearly all patients survive the procedure.
Studies show that hospitals that perform a high volume of Whipple procedures achieve a much lower mortality rate than hospitals that perform few pancreatic resections. The rate of complications and death at the University of Chicago Medical Center is between 1 to 2 percent, which is equivalent to and in many cases better than other large academic medical centers.
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Q. How do I choose the physician and medical center that are right for me?
A. Questions to ask the physician:
- How many of these operations do you (and your group) perform each year? In 2007, University of Chicago surgeons performed more than 250 gastrointestinal cancer surgeries, which is more than any other medical center in the Chicago area.
- What are your complication rates? How many of your patients survive the operation? At the University of Chicago, the rate of complications and death for the Whipple procedure is 1 to 2 percent, which is equivalent to--and in many cases better--than other large academic medical centers.
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