The Whipple Procedure

When all things looked their worst, nothing was more inspiring than reading about how other people survived against the odds and coped with their situations. There are as many different ways to survive as there are patients, and so we can learn something different from each one.

This section of our blog brings to you some stories of people who are pancreatic cancer patients; living with and sometimes beyond pancreatic cancer and who want to help others by recounting their experiences. We got included pancreatic cancer patient stories. Their stories are their own, either written themselves or a family member.

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Somebody I love was recently diagnosed with duodenal cancer. There were 2 small metastases on his liver, and I think there was also some metastases in his lymph nodes. The duodenal tumor has now grown and the duodenum is completely obstructed. They are doing laparascopic gastric partitioning gastrojejunostomy. I understand that this is a palliative procedure, and I’m wondering why the Whipple procedure can’t be done and the metastases treated with chemo?

If a person has got pancreatic cancer, and the doctor recommends whipple procedure. in Whipple procedure, the doctor will cut the bile duct , part of the duodenum and sometimes part of the stomach as well. My question is , if the cancer is at the pancreas, why did the doctor cut out the bile cuit and duodenum as well?

Many people who have pancreatic cancer and who are thinking about surgery may have the question: Who Should Perform the Whipple Procedure?

The Whipple procedure is a operation that involves the removal of the head of the pancreas for people who have pancreatic cancer. This is a very delicate and often dangerous procedure

Who Should Perform the Whipple Procedure?
The Whipple procedure takes a few hours to complete and it requires a surgeon with great skill. The pancreas is a very complex area and between patients there can be large difference in the blood vessels and ducts of each pancreas.

When diagnosed with pancreatic cancer the survival rate is often low. The Whipple procedure can extend the life of people who have tumors only in the head of the pancreas. If the tumors have spread into other areas such as the liver, the abdominal cavity or the lungs then this procedure may not help.

This surgery is very high risk and many surgeons don’t wish to perform the operation due to its complexity and high death rate. In recent times more surgeons have experience with this type of surgery and the improvements in post op care and diagnosis has helped reduce the death rate when undertaking this surgery.

Many people are still unsure about who should perform the Whipple Procedure. If you are one of these then you need to contact a specialist hospital that does more than 20 pancreas surgeries per year. This way you can be assured of a specialist surgeon and the right medical care which can reduce the rate of death from the Whipple Procedure to less than 1%.

You can also ask your local doctor if he knows who should perform the Whipple procedure. He may be able to direct you to a specialist that has experience with this type of surgery.

Laparoscopic Whipple procedure is a complex but well researched and documented surgical procedure that is used to treat pancreatic cancer. The treatment of pancreatic cancer is usually determined by the age and general health of the patient as well as the location and stage of the tumor. However, the main goal of all the cancer treatments is to totally eliminate the cancer from the body.

Laparoscopic Whipple procedure is one of the pancreatic cancer treatments. It is a less invasive procedure that removes the pancreas’ head, part of the gall bladder, duodenum and bile duct with the help of a tiny camera known as a laparoscope.

The laparoscopic Whipple procedure is performed by making six tiny incisions through the abdominal wall. A laparoscope is inserted to the body via one of the incisions while other essential instruments are inserted through the remaining incisions. The surgeon performs the operation with the help of these instruments while following the guidance of the laparoscope images that are conveyed in the operating room through a monitor. This operation takes about five to six hours and the patient is allowed to leave the hospital after six to eight days.

The laparoscopic Whipple procedure is a very specialized and complex procedure. This means that there are certain factors that are considered before a doctor recommends this operation. These factors include; the presence of pancreatic cancer, the severity of the cancer, the age and health of the patient and type of cancer. However, this operation is mainly offered to patients who suffer from cystic tumors, chronic pancreatitis,ampullary cancer and islet pancreas cell tumors.

Before any patient undergoes the laparoscopic Whipple procedure, it is important for them to understand the basics of the operation. This helps them to prepare for the operation both physically and psychologically. Maintaining a healthy balanced diet after the laparoscopic Whipple procedure boosts quick and uncomplicated recovery.

People who will undergo surgery for pancreatic or duodenal cancer need to know about the risks during and after the Whipple procedure. In general, major surgeries impose risks and possible complications. Therefore, clients need to understand the surgical process and must consent only after getting enough information about what to expect about the procedure. The health care team’s topmost concern is overall treatment outcome. Surgical intervention is purposely conducted to cure and in worst cases to prolong life. Physicians resort to surgical procedure after all other clinical management have been exhausted with little or no success.

Common Surgical Risks During and After the Whipple Procedure
Most common surgical difficulties associated to Whipple procedure are anaesthesia complications, wherein patients could possibly lead to respiratory failure and weakness post-surgery. Other problems include those that are related to intubation – the process of inserting a tube that allows breathing during operations like trauma on the throat and the lungs.

Apart from complications associated to anaesthesia and intubation, bleeding is also a major risk during and after the Whipple procedure. Moreover, this risk becomes more profound with clients belonging to religious affiliations that prohibit blood transfusion. Another risk that is present during and after the Whipple procedure is the deep vein thrombosis or formation of clots that block the flow of blood to vital organs.

Thorough physical examination and medical history taking prior to a Whipple procedure is always necessary. Previous history of clots makes a client more prone to deep vein thrombosis. Blood clots may become lodged in the lungs or the brain as they travel through the bloodstream causing either pulmonary complications or brain attacks, which is another medical emergency that requires immediate management.

The Whipple process may take between 4 to 8 hours and prognosis depends on the overall health condition of the patient prior to the surgery.

Complications may arise even days or weeks after surgery so patients and primary caregivers must always be observant for high-grade fever, low blood pressure and erratic pulses, which could all indicate infection or bleeding. Moreover, recovery time differs for each individual and they are advised to follow nutritional requirements to facilitate wound healing. Also, since clients who have undergone the Whipple procedure are immunocompromised so visits must be limited so that the client will not suffer from infections.

To sum it up, risks during and after the Whipple Procedure are manageable. However, patients as well as the caregivers must understand that people respond differently from treatments. The procedure has been highly successful for people who are on the early to intermediate stages of cancer. Knowing these risks should lessen the anxiety and facilitate recovery better among people who will undergo the procedure.

The Whipple procedure is a major type of surgery done to excise the pancreatic head. It is also called pancreaticoduodenectomy.

This surgery is called the Whipple procedure named after an American surgeon called Allen Whipple who refined the procedure in 1935. He also reduced the surgery from a two step process into a single step process making it less involving. This type of surgery was, however first described in 1898 by an Italian surgeon and done in 1909 by Kausch in Germany.

Indications for the Whipple procedure are mainly malignant and sometimes benign tumors of the pancreatic head. In addition, it could done in cases of cancers of the gall bladder, the bile duct or the duodenum. The pancreas is a thin, leaf like structure which is located just behind the stomach. Its contains cells whose main function is in the production of insulin and other digestive enzymes which assist in the digestion of food.

Patients who end up needing this operation usually present with a deep yellow color of the eyes (deep jaundice), skin itchiness, pale colored stools and dark colored urine. These are the definitive symptoms of obstructive jaundice and further investigation is required. The operation is performed on only 20% of these cases as it cannot be done when the tumor has spread too much. Therefore careful investigation is necessary prior to the operation.

In the Whipple procedure, the pancreatic head, part of the biliary tree, the gall bladder, the last part of the stomach together with the duodenum are resected. After their resection, the remaining section pancreatic section, the bile duct and the proximal stomach are anastomosed (joined) back to the intestine. This enables the digestive enzymes in the pancreas, bile and food from the stomach to flow allowing the digestion process to continue normally. The duration of the procedure is approximately five to seven hours unless complications occur. After surgery, the patient is kept on intravenous infusion for four to six days and is not allowed to eat orally. This ensures complete healing of the anastomotic site. He or she is given antibiotics to prevent infection and analgesics for the pain. The patient is encouraged to ambulate as soon as possible and is taught respiratory exercises to avoid chest infections. Hospital stay for this procedure is between one and two weeks.

After undergoing the procedure, the patient may feel fatigued, have a decreased appetite and it may take him or her upto two or three months to get back to his or her normal activity level. Out patient follow up is very important post operatively.

Immediate complications which may result after the Whipple procedure are: delayed stomach emptying, leakage at the anastomosic site, bleeding either during or after the operation and infection. Anaesthetic related complications also occur more rarely. More long term complications are: malabsorption of food due to excision of a portion of the pancreas, weight loss and change in diet. There is also a small risk of developing diabetes after this operation depending on how much of the pancreas is removed.

The Whipple procedure is potentially the only definitive cure for this type of cancer. The five year survival rate for patients who undergo this operation is twenty percent. For better results, adjuvant chemotherapy is given to some patients.