Surgical Procedures: Whipple Procedure (Pancreaticoduodenectomy)

What is a Whipple procedure and how is it performed?

A Whipple procedure is a surgery that can be used to treat some cases of pancreatic cancer. There are two types of Whipple procedures commonly used:

• Standard Whipple (pancreaticoduodenectomy): Removal of the pancreatic head (and at times the body), gallbladder, bile duct, and a part of both the stomach (pylorus), small intestine (duodenum), and nearby lymph nodes. The pancreas that is left will continue to make digestive juices and insulin.
• Pylorus Preserving Whipple: This is the same as a standard Whipple, but the pylorus (the opening from the stomach to the small intestine) is left in place.

During these procedures, the remaining common bile duct and pancreas will be connected to the small intestine. This is done so that pancreatic enzymes and bile can pass through to the small intestine.

A Whipple procedure can be done to treat some cases of:

• Pancreatic head cancer.
• Duodenum cancer.
• Cholangiocarcinoma.
• Cancer of the ampulla.
• Pancreatic neuroendocrine tumors. 
• Some benign (non-cancerous) conditions.

What are the possible risks/side effects of having a Whipple Procedure?

The risks of a Whipple include:

• Pancreatic fistula (leakage of pancreatic juice from the area where the pancreas is attached to the intestine).
• Gastroparesis (stomach muscles do not work as well as they should).
• Delayed gastric emptying.
• Long-term digestive issues, bowel habit changes, malabsorption, needing to change your diet, diabetes, and weight loss.
• Bleeding.
• Infection.

What is recovery like?

The hospital stay from a Whipple is often about a week. While in the hospital you will have a nasogastric (NG) tube, which is placed through the nose, down the throat, ending in the stomach. It is used to drain stomach contents and prevent vomiting. Often, it is removed the day after surgery. A bladder catheter will remain in place to drain your urine for up to 3 days. Abdominal drains will remove fluid from the belly.

Your medical team will discuss with you the medications you will be taking, such as those for pain, blood clots, infection, and constipation prevention, and/or other conditions.

Your team and a dietitian will work with you on changing your diet.  Pancreatic enzyme pills may be prescribed to prevent diarrhea and aid in food digestion.

Your healthcare provider will discuss your activity restrictions while you are at home based on the extent of your surgical procedure. Often it is recommended that you:

• Eat small frequent meals.
• Slowly increase activity on a daily basis, take naps and get a good night’s sleep.
• No heavy lifting.
• Do not drive while taking narcotic pain medication.
• Prevent constipation by drinking fluids and/or taking stool softeners.

What will I need at home?

• Thermometer to check for fever, which can be a sign of infection.
• Incisional care supplies, which will likely be given to you at the hospital.

Symptoms to report to your healthcare team include:

• Fever. Your care team will tell you at what temperature they should be contacted. 
• Chills, incisional drainage, or redness.
• Any new or worsening pain. 
• Nausea, vomiting, diarrhea, and/or constipation.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection, and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation. 

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.