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.