Whipple Procedure

ExitCare Image The Whipple procedure is surgery to remove part of the pancreas. The pancreas is an important organ. It is located in the upper part of the abdomen. The pancreas makes digestive juices and insulin. The part of the pancreas that is removed is called the head of the pancreas. This may need to be done if the pancreas is badly infected (chronic pancreatitis). It may also be done if there is cancer near this part of the pancreas.

More than the head of the pancreas may be taken out during a Whipple procedure. Part of the upper intestine (duodenum) and the gallbladder may also be removed. Sometimes, part of the stomach is removed, too. Then, the remaining part of the pancreas is connected to the small intestine.

LET YOUR CAREGIVER KNOW ABOUT:

  • Allergies to food or medicine.

  • Medicines taken, including vitamins, herbs, eyedrops, over-the-counter medicines, and creams.

  • Use of steroids (by mouth or creams).

  • Use of tobacco and alcohol.

  • Previous problems with anesthetics or numbing medicines.

  • History of bleeding problems or blood clots.

  • Previous surgery.

  • Other health problems, including diabetes, kidney problems, trouble urinating, or problems with your breathing.

  • Possibility of pregnancy, if this applies.

RISKS AND COMPLICATIONS

  • Blood clots may form in your legs during the procedure. This sometimes happens during long surgeries on the abdomen. Blood clots may rarely travel to the lungs and cause chest pain and difficulty breathing.

  • Bleeding.

  • Infection of the surgical cut (incision) and wound or a deep infection inside the abdominal cavity (abscess).

  • Infection in the lungs (pneumonia).

  • Fistula. This is leaking that happens at the spot where the pancreas joins the small intestine.

  • Loss of appetite. This can cause you to lose a lot of weight. The weight loss may be permanent.

  • Diabetes. This disease means there is too much sugar (glucose) in your blood. Removing part of the pancreas sometimes causes diabetes. You may need to take insulin or other medicine to treat diabetes.

  • Low levels of digestive enzymes. These are substances that you need to digest food. They are made by the pancreas. Taking out part of the pancreas sometimes means your pancreas cannot make enough digestive enzymes. You may need to take supplements to replace them.

  • Slow emptying of your stomach.

  • Damage to other parts of the pancreas.

BEFORE THE PROCEDURE

  • You may need to have several tests, such as:

  • Blood tests.

  • A chest X-ray.

  • An electrocardiography. This test checks your heart function.

  • Ask your caregiver if you should change or stop any of your regular medicines.

  • You will probably need to clean out your digestive system. This is called bowel prep. Your caregiver will tell you when to start this. You cannot eat solid food. You can drink only clear liquids. You may need to take medicine to make you go to the bathroom.

  • You cannot eat or drink anything right before the surgery. Your caregiver will tell you exactly when to stop eating and drinking.

PROCEDURE

The Whipple procedure may take 3 to 7 hours.

  • You will be given an intravenous line (IV). A needle will be inserted in your arm. Medicine will be able to flow directly into your body through the IV. You may be given:

  • Antibiotic medicine to prevent infection.

  • A blood thinner. This helps prevent blood clots.

  • You will be given medicine that makes you sleep (general anesthetic).

  • A nasogastric tube will be put in. This is a flexible tube that goes through your nose and into your stomach.

  • A tube will be placed into your urinary bladder to measure your urine production during surgery. The bladder tube may remain in place for a day or longer after surgery.

  • Once you are asleep, the surgeon will make a long incision in the upper part of your abdomen.

  • The head of the pancreas, duodenum, and gallbladder will be removed. Part of the stomach may also be removed.

  • Your surgeon will connect the rest of the pancreas to the small intestine.

  • Several tubes or drains, and a feeding tube may be put inside your abdomen. Any extra fluid will drain through these tubes for a while after the surgery. The feeding tube allows food and nutrition to flow directly into the upper part of the small intestine.

  • The surgeon will close the incision. Stitches (sutures) or staples may be used.

  • A medicated bandage (dressing) will be put over the incision. The bandage will also cover any drainage tubes.

AFTER THE PROCEDURE

  • You will stay in a recovery area until the anesthesia has worn off. Your blood pressure and pulse will be checked every so often. Then, you will be taken to a hospital room.

  • Some abdominal pain near the incision is expected after a Whipple procedure. At first you will get pain medicine through the IV. Then, you may be taught how to control your own pain medicine with a pump. After a few days, you will likely get shots for pain or you may start taking pain pills.

  • Your stomach and intestines will not function for a few days after surgery. This period of intestinal sleep or inactivity is called ileus.

  • You may feel nauseous after surgery. You may not be able to eat right after your surgery. You may be fed through either a nasogastric tube or an intestinal feeding tube. You will receive fluids through the IV. These fluids will continue for a few days. When your intestinal function returns, the nasogastric tube can be taken out. After that, you can slowly go back to eating regular food. The IV will be taken out when you do not need it for medicine or fluids.

  • You may need to wear elastic stockings. The goal is to keep blood flowing in your legs. This helps prevent blood clots. The stockings may have air pumped into them. They are called compression stockings or sequential circulating devices.

  • You will be required to perform deep breathing exercises after your surgery to prevent pneumonia. You will be taught how to do these exercises by a respiratory therapist or nurse.

  • You will be required to walk while you are in the hospital. Walking prevents blood clots in the legs and decreases the chance of developing pneumonia.

  • You may need insulin or other drugs to control your blood glucose.

  • You may need antibiotics to prevent infection.

  • You may need blood thinners to prevent blood clots.

  • The drainage tubes will be taken out when no more fluid is draining. This may happen before you go home or you may need to return to have the tubes taken out.

  • Most people stay in the hospital for about 7 days.