Whipple Operation (pancreaticoduodenectomy)
A Whipple procedure — also known as a pancreaticoduodenectomy — is a complex operation to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct.
The Whipple procedure is used to treat tumors and other disorders of the pancreas, intestine and bile duct. It is the most often used surgery to treat pancreatic cancer that's confined to the head of the pancreas. After performing the Whipple procedure, your surgeon reconnects the remaining organs to allow you to digest food normally after surgery.
The Whipple procedure is a difficult and demanding operation and can have serious risks. However, this surgery is often lifesaving, particularly for people with cancer.
Why it's done
A Whipple procedure may be a treatment option for people whose pancreas, duodenum or bile duct is affected by cancer or other disorder. The pancreas is a vital organ that lies in the upper abdomen, behind your stomach. It works closely with the liver and ducts that carry bile. The pancreas releases (secretes) enzymes that help you digest food, especially fats and protein. The pancreas also secretes hormones that help manage your blood sugar.
Your doctor may recommend you have a Whipple procedure to treat:
- Pancreatic cancer
- Pancreatic cysts
- Pancreatic tumors
- Ampullary cancer
- Bile duct cancer
- Neuroendocrine tumors
- Small bowel cancer
- Trauma to the pancreas or small intestine
- Other tumors or disorders involving the pancreas, duodenum or bile ducts
The goal of doing a Whipple procedure for cancer is to remove the tumor and prevent it from growing and spreading to other organs. This is the only treatment that can lead to prolonged survival and cure for most of these tumors.
Risks of Whipple Operation
The Whipple procedure is a technically difficult operation, often involving open surgery. It carries risks both during and after surgery. These may include:
- Bleeding at the surgical areas
- Infection of the incision area or inside your abdomen
- Delayed emptying of the stomach, which may make it difficult to eat or to keep food down temporarily
- Leakage from the pancreas or bile duct connection
- Diabetes, temporary or permanent
Extensive research shows that surgeries result in fewer complications when done by highly experienced surgeons at centers that do many of these operations. Don't hesitate to ask about your surgeon's and hospital's experience with Whipple procedures and other pancreatic operations. If you have any doubts, get a second opinion.
How you prepare
Your surgeon will review several factors to evaluate which approach to your surgery is best in your situation. He or she will also assess your condition and ensure that you are healthy enough for a complex operation. You may require some additional medical tests and optimization of some of your health conditions before proceeding to surgery.
A Whipple procedure may be done in various ways:
- Open surgery. During an open procedure, your surgeon makes an incision in your abdomen in order to access your pancreas. This is the most common approach and the most studied.
- Laparoscopic surgery. During laparoscopic surgery, the surgeon makes several smaller incisions in your abdomen and inserts special instruments, including a camera that transmits video to a monitor in the operating room. The surgeon watches the monitor to guide the surgical tools in performing the Whipple procedure. Laparoscopic surgery is a type of minimally invasive surgery.
- Robotic surgery. Robotic surgery is a type of minimally invasive surgery in which the surgical tools are attached to a mechanical device (robot). The surgeon sits at a console nearby and uses hand controls to direct the robot. A surgical robot can use tools in tight spaces and around corners, where human hands may be too large to be effective.