Whipple Surgery

Whipple surgery ?

The Whipple procedure is an operation to remove a pancreatic tumour and a lot of the tissue around it. After a large cut is made in your belly, the surgeon will look at the pancreas and other organs in the area, including lymph nodes, to see if the cancer has spread. Tissue samples will be taken for a biopsy.

When the surgeon is satisfied that the tumour has not spread and can be removed entirely, he or she takes out the part of the pancreas containing the tumour. The surgeon will also take out the first part of the small intestine, the bile duct, the gallbladder, and nearby lymph nodes. Sometimes the lower part of the stomach is also removed. The goal of surgery is to remove the tumour and some of the normal tissue around it. The normal tissue is examined under a microscope to see if it is free of cancer cells. This is known as getting "clear margins." Having clear margins improves the chances—but doesn't guarantee—that all cancer cells have been removed.

The second part of the surgery involves sewing your digestive tract back together. Sometimes this operation can be done with laparoscopic surgery, using several small incisions instead of one large one.

Standard Whipple Procedure

In a standard Whipple procedure, the surgeon removes the head of the pancreas, the gallbladder, part of the duodenum which is the uppermost portion of the small intestine, a small portion of the stomach called the pylorus, and the lymph nodes near the head of the pancreas. The surgeon then reconnects the remaining pancreas and digestive organs so that pancreatic digestive enzymes, bile, and stomach contents will flow into the small intestine during digestion.

Pylorus preserving Whipple Procedure

In another type of Whipple procedure known as pylorus preserving Whipple, the bottom portion of the stomach, or pylorus, is not removed. Taking out the head of the pancreas is called pylorus preserving pancreaticoduodenectomy (PPPD).

Laparoscopic Wipple Procedures

A laparoscopic Whipple procedure may be offered to select individuals. The laparoscopic Whipple procedure is performed through small incisions in the abdominal wall. A laparoscope, a long thin tube with a lighted camera at its tip, is inserted through one incision. The surgeon operates using specially designed surgical instruments placed through the remaining incisions, guided by the laparoscope images shown on a monitor in the operating room. Conventional surgeries require a longer incision and wider opening of the abdomen. With laparoscopic procedures, surgeons are generally able to reduce blood loss and risk infection for the patient.

The most common post-surgical complication of pancreatoduodenectomy is leaking of pancreatic juices from the incision. If this occurs, a drain may be inserted through the skin to allow drainage for several weeks after surgery. Weight loss is another frequent complication of the Whipple procedure. Diabetes is a potentially serious concern for some people (a minority) after surgery. In general, although many people do very well after the Whipple procedure, some develop immediate complications that affect their quality of life.