Whipples Surgery - Procedure, Benefits, Risks, Recovery

A Whipple procedure, also known as a pancreaticoduodenectomy is a complex surgery. The surgeon performs the procedure to remove the head of the pancreas, duodenum (the first part of the intestine), bile duct, and gallbladder. It is used to treat tumours and other abnormalities of the pancreas, bile duct, and intestine. Although complex, this is the most used surgical procedure for treating the pancreatic tumour. It is sometimes also advised for cancers in the bile duct. However, it is rarely performed in the case of inflammatory conditions like pancreatitis.

The benefits of the Whipple procedure are that 

1. prolong a patient's life,
2. or even potentially cure them of cancer.
3. For some patients, the goal might be to prevent or relieve symptoms such as pain or blockage of the bile duct or stomach.

Why is this procedure done? 

1. Your doctor may advise the Whipple procedure to treat the following medical conditions:-
2. Pancreatic cancer
3. Pancreatic tumour
4. Small bowel cancer
5. Bile duct cancer
6. Pancreatic cyst
7. Pancreatitis
8. Small intestine cancer
9. Neuroendocrine cancer
10. Cancer of ampulla of vatter (A space where tubes from liver and pancreas come together)
11. Trauma to the pancreas or other small intestine

The treatment procedure of Whipple procedure 

Whipple procedure is done by three approaches. These are open, laparoscopic and robotic surgery.

1)Open: In this approach, the doctor makes a large cut in the abdomen to reach the affected part. This procedure is most common and is done physically by surgeons.

2)Laparoscopic: In this process, the surgeon makes several minor cuts instead of one large cut. Then they insert a special device called a laparoscope which is a  thin tube having a camera on its head. This camera shows images of the internal organs on a monitor. It guides the surgeons throughout the procedure. It is a minimally invasive surgery and has relatively fewer complications than open surgery.

3)Robotic: This process is done by a mechanical device (robot). The surgeon guides the robotic arms through the console. It is a minimally invasive surgery. The robotic procedure allows the surgeons to perform the procedure with high precision.

1. The Whipple procedure is done under general anaesthesia.
2. A qualified anesthesiologist will inject a precise dose of general anaesthesia into the veins of the patient.
3. The surgeon will create one large incision in the abdominal area of the patient. In the case of the laparoscopic approach, the surgeon will make some minor cuts instead of one large cut.
4. Then they will check the nearby organ to make sure that cancer has not spread to the nearby organs.
5. Then the surgeon removes the affected organs and attaches the remaining part of the stomach to the jejunum (middle part of the intestine).
6. The remaining part of the common bile duct and pancreas are also attached to the jejunum. 
7. After completing the procedure, the cuts are then sutured using self-dissolving sutures.

What to expect before the Whipple procedure? 

1. You should tell the nurse and staff about any medications you are taking. 
2. Your surgeon will ask you to stop eating and drinking the night before the surgery. It is because it will make the body suitable for anaesthesia.
3. Before surgery starts, an intravenous line is put into your veins. It is used to deliver the medications during operation.

What to expect on the day of the Whipple procedure? 

1. Always reach the hospital at the scheduled time.
2. Nurse and staff members will ask your name, age and type of procedure. It is to minimise the chances of any errors.
3. When going for a Whipple procedure, always wear loose clothes. 
4. After registration and entering the pre-operative area, you will be asked to wear the surgery gown.
5. Before surgery, the doctor may advise you to remove jewellery or body piercings, any other metal and hearing aids, or any prosthetic devices.
6. All the vitals of the patient, like blood pressure and heart rate, are continuously recorded on a monitor throughout the procedure.

What to expect during surgery? 

1. The Whipple procedure takes around 4 to 6 hours to complete.
2. If the procedure is done by an open approach, it includes a large cut into the abdomen. The incision size depends upon the technique used.
3. You will get a dose of anaesthesia before surgery. 
4. Once you are asleep, a breathing tube is inserted into the mouth to facilitate breathing during surgery.
5. A hollow tube will be inserted from the urethra to the bladder. It is done for draining urine during and after the operation.

What to expect after surgery? 

1. You may have to stay for one to two days in the intensive surgical unit.
2. An estimate of 6 to 10 days of hospital stay can also be possible depending upon the surgical approach used.
3. Most people may go directly to the surgical recovery room after the procedure.
4. Nursing staff will regularly monitor the progress of the patient even several times a day. In addition, they will periodically check for any signs of infections and complications after the surgery.
5. You may be admitted to the intensive care unit after the surgery if you have severe medical conditions. They will give you fluid, medication and nutrition through the intravenous line injected into your arm.

First follow-up appointment

1. During the initial eight weeks after getting discharged from the hospital, you should regularly visit the hospital. Some surgeons may schedule the follow-up appointments after every two weeks for the first two months. On the follow-up appointments, the surgeon may check the following:-
2. Your incision will be examined for any signs of infection at the site of sutures.
3. Laboratory and surgical reports may be evaluated.
4. The surgeon may check the diet and bowel movement.
5. Pain management will also be done.
6. It may also involve instructions on a diet, wound care, and home care.