Whipple Procedure Surgery in Delhi, India

A Whipple’s procedure may be the best treatment option for patients with cancers of the head of the pancreas, ampulla of Vater, second or third part of duodenum or lower bile duct.

The doctor may recommend the patient to get a Whipple’s procedure for various conditions such as :

• Pancreatic cancer
• Pancreatic cysts
• Pancreatic tumours
• Chronic Pancreatitis
• Ampullary cancer
• Cancer of the bile duct
• Neuroendocrine tumours
• Duodenal cancer
• Various other tumours or disorders involving the pancreas, duodenum or bile ducts

Pancreatic cancer is the most common reason for the surgeon to perform a Whipple’s procedure. A Whipple’s procedure can be performed in various ways:

• Open surgery- During this procedure, the surgeon marks an incision in the abdomen to access the pancreas. This is the most common approach.
• Laparoscopic surgery- During this surgery, the surgeon makes several smaller incisions in the abdominal area and puts inside several instruments along with a camera that helps to transmit videos to a monitor in the operating room. The surgeon looks at the monitor to guide the surgical tools in conducting Whipple's procedure. This is a form of minimally invasive surgery.
• Robotic surgery- Robotic surgery is also a type of minimally invasive surgery in which the surgical tools are attached to a robot. The surgeon sits nearby and uses hand controls to direct the robot. A surgical robot can use certain tools in tight spaces and around corners.

If patients have cancer, they may go through either radiation or chemotherapy before having the surgery. 

The surgeon will instruct the patients to stop taking certain particular medications in the days leading up to their surgery. Patients should do the following:

• Avoid food and drinks for eight hours before going to the hospital unless directed otherwise.
• Quit smoking at least two weeks before the procedure to improve heart and lung conditions.
• Avoid taking herbal supplements for one to two weeks before the surgery as directed by the surgeon.
• Have certain blood pressure medications

Whipple’s procedure can be described in a few steps:

• A large incision is made in the abdomen, or there will be a couple of small ones if the mode of surgery is laparoscopic surgery).
• The doctor will separate the head of the pancreas where the tumour is present along with the duodenum, the lower section of the bile duct, the gall bladder and, at times, a part of the stomach.
• The intestinal continuity is restored by attaching the remnant pancreas, bile duct and stomach to the small intestine.

Few people who go through the Whipple’s procedure present with certain complications, which include:

• Pancreatic fistula due to leak from pancreatic anastomosis
• Bleeding
• Infection

In the delayed postoperative period, some patients may develop the following: 

• Diabetes is either temporary or permanent
• Weight loss

Contact the doctor if the following issues occur:

• Fever
• Severe pain in the abdomen
• Inability to tolerate diet or vomiting
• Pus discharge from the incision

For the majority of tumours and cancers of the pancreas, Whipple’s procedure is the only treatment option consistent with long-term survival or cure. The survival rate for patients undergoing Whipple’s procedure has improved over the last two decades. The chances of long-term survival after a Whipple’s procedure depend on many factors, such as indication for surgery, cancer stage, etc.

1. What is the Whipple procedure?

The Whipple procedure, also known as pancreaticoduodenectomy, is a surgical procedure performed to treat certain conditions affecting the pancreas, bile duct, and small intestine.

2. When is the Whipple procedure recommended?

The Whipple procedure is recommended for various conditions, including pancreatic cancer, tumours of the bile duct or duodenum, chronic pancreatitis, and certain benign pancreatic or bile duct disorders.

3. What conditions or diseases can be treated with the Whipple procedure?

The Whipple procedure can treat pancreatic cancer, tumours of the bile duct or duodenum, chronic pancreatitis, ampullary cancer, and certain benign pancreatic or bile duct disorders.

4. How is the Whipple procedure performed?

The Whipple procedure involves the removal of the head of the pancreas, a portion of the bile duct, the gallbladder, and a part of the small intestine. The remaining organs are then reconstructed to restore the normal flow of digestive juices and bile.

5. What are the different components of the Whipple procedure?

The Whipple procedure involves the removal of the head of the pancreas, the common bile duct, the gallbladder, and a portion of the duodenum (the first part of the small intestine). The remaining organs are then reconnected to restore normal digestion.

6. What are the potential risks and complications of the Whipple procedure?

Potential risks and complications of the Whipple procedure include infection, bleeding, leakage at the surgical site, delayed gastric emptying, bile duct complications, pancreatic fistula, and rare complications such as blood clots and pneumonia.

7. How long does it take to recover from the Whipple procedure?

The recovery time after the Whipple procedure can vary, but generally, it may take several weeks to a few months to fully recover and resume normal activities.

8. What dietary changes are necessary after the Whipple procedure?

Following the Whipple procedure, dietary changes may be necessary to manage digestion and absorption. These changes may include a low-fat diet, smaller and more frequent meals, pancreatic enzyme supplementation, and adjustments based on individual needs.

9. Can the Whipple procedure be performed using minimally invasive techniques?

Yes, in select cases, the Whipple procedure can be performed using minimally invasive techniques such as laparoscopy or robotic-assisted surgery. These approaches may result in smaller incisions, less pain, and shorter recovery times for some patients. However, open surgery remains the standard way of performing the Whipple procedure.

10. Is the Whipple procedure a major surgery?

Yes, the Whipple procedure is considered a major surgery due to the complexity and extent of organ removal and reconstruction involved.

11. What pre-operative preparations are required for the Whipple procedure?

Pre-operative preparations for the Whipple procedure may include medical evaluations, imaging tests, blood work, and discontinuation or adjustment of certain medications. Bowel preparation and dietary restrictions may also be advised.

12. Will I have a scar after the Whipple procedure?

Yes, the Whipple procedure involves making an incision in the abdomen, so it is likely that you will have a scar. The size and appearance of the scar can vary depending on the surgical technique used and individual factors.

13. Can the Whipple procedure be used to treat pancreatic cancer?

Yes, the Whipple procedure is commonly performed to treat pancreatic cancer, particularly if the tumour is confined to the head of the pancreas and has not spread to other organs.

14. Can the Whipple procedure be used to treat tumours in other organs?

The Whipple procedure primarily focuses on treating conditions involving the pancreas, bile duct, and duodenum. However, in some cases, it may be used to treat tumours affecting nearby organs, such as the ampulla of Vater.

15. What is the success rate of the Whipple procedure for treating pancreatic conditions?

The success rate of the Whipple procedure for treating pancreatic conditions depends on various factors, including the specific condition being treated and the stage at which it is diagnosed. It is best to discuss the success rate with your healthcare provider, as it can vary.

16. Are there any alternatives to the Whipple procedure for certain conditions?

In some cases, alternative treatment options such as chemotherapy, radiation therapy, or targeted therapies may be considered. The suitability of alternatives depends on the individual's specific condition and other factors and should be discussed with a healthcare provider.

17. How long will I need to stay in the hospital after the Whipple procedure?

The length of hospital stay after the Whipple procedure can vary, but it typically ranges from one to two weeks, depending on individual factors and the extent of the surgery.

18. What are the potential long-term effects of the Whipple procedure?

Potential long-term effects of the Whipple procedure can include changes in digestion and absorption, weight loss, diabetes or glucose intolerance, vitamin deficiencies, and the need for pancreatic enzyme supplementation. Regular follow-up care is important to manage and address these potential effects.

19. Can the Whipple procedure cause digestive problems or malabsorption?

Yes, the Whipple procedure can potentially cause digestive problems and malabsorption due to changes in the normal flow of digestive juices and bile. These issues may require dietary adjustments and sometimes the use of pancreatic enzyme supplements.

20. Can the Whipple procedure be performed on elderly patients?

The Whipple procedure can be performed on select elderly patients who are otherwise healthy and able to tolerate the surgery. The decision to proceed with the surgery in elderly patients is based on a thorough evaluation of their overall health and individual circumstances.

21. What should I expect during the recovery period after the Whipple procedure?

During the recovery period after the Whipple procedure, you can expect a gradual improvement in strength and energy levels. Follow-up appointments, monitoring, and adherence to dietary recommendations and medication regimens are crucial for a successful recovery.

22. Can I resume normal activities after the Whipple procedure?

The ability to resume normal activities after the Whipple procedure varies for each individual and depends on factors such as overall health, the extent of surgery, and the healing process. It is important to follow the guidance of your healthcare provider regarding activity restrictions and gradually return to normal activities.

23. Are there any dietary restrictions after the Whipple procedure?

Following the Whipple procedure, dietary restrictions may be necessary, such as avoiding high-fat foods, eating smaller and more frequent meals, and limiting certain foods that may cause digestive discomfort. These restrictions aim to support digestion and minimize potential complications.

24. Will I need nutritional supplements after the Whipple procedure?

Nutritional supplements may be necessary after the Whipple procedure to address potential deficiencies and support overall nutrition. This may include pancreatic enzyme supplements, vitamins, and minerals as prescribed by your healthcare provider.

25. Can the Whipple procedure be used to treat chronic pancreatitis?

The Whipple procedure is generally not the first-line treatment for chronic pancreatitis. It may be considered in specific cases where there are complications or other factors that warrant surgical intervention. The appropriateness of the Whipple procedure for chronic pancreatitis depends on individual circumstances and should be discussed with a healthcare provider.

26. Can the Whipple procedure be performed on individuals with pre-existing medical conditions?

The decision to perform the Whipple procedure on individuals with pre-existing medical conditions depends on the specific condition, overall health, and surgical risk assessment. Each case is evaluated individually, and the feasibility of the procedure is determined by the healthcare team.

27. What are the signs of complications after the Whipple procedure?

Signs of complications after the Whipple procedure may include excessive fever, significant pain, vomiting, bleeding, infection, leakage at the surgical site, or other less common complications. It is important to promptly report any concerning symptoms to your healthcare provider for evaluation and management.

28. Can the Whipple procedure be used to treat cystic fibrosis-related pancreatic issues?

The Whipple procedure may be considered a treatment option for cystic fibrosis-related pancreatic issues, particularly if there are complications such as severe pancreatic damage or blockage of the bile duct. The suitability of the procedure would be assessed on an individual basis.

29. Can the Whipple procedure be performed on paediatric patients?

The Whipple procedure can be performed on paediatric patients in certain cases where there are specific indications and appropriate evaluation of the risks and benefits. The decision to proceed with the procedure in paediatric patients is made on a case-by-case basis and requires specialized care.

30. Can the Whipple procedure be used to remove benign tumours in the pancreas?

The Whipple procedure can be used to remove certain benign tumours in the pancreas, depending on their location and characteristics. The decision to proceed with the procedure for benign tumours is based on individual factors and the recommendations of the healthcare team.

31. What is the role of pain management after the Whipple procedure?

Pain management plays a crucial role after the Whipple procedure to ensure comfort and facilitates the healing process. A combination of pain medications, including opioids and other analgesics, as well as non-medication approaches, such as breathing exercises or physical therapy, may be employed.

32. Can the Whipple procedure be used to treat ampullary cancer?

Yes, the Whipple procedure can be used to treat ampullary cancer, which is a type of cancer that affects the ampulla of Vater, the structure where the common bile duct and pancreatic duct meet. The specific approach depends on the characteristics and stage of the cancer.

33. Can the Whipple procedure be performed on individuals with diabetes?

The Whipple procedure can be performed on individuals with diabetes. However, it is important to manage diabetes carefully both before and after the procedure to maintain stable blood sugar levels and optimize overall health during the recovery process.

34. How does the Whipple procedure affect digestion and absorption of nutrients?

The Whipple procedure can affect digestion and absorption of nutrients due to changes in the normal flow of digestive juices and bile. This may lead to challenges in digesting fats and absorbing certain nutrients, necessitating dietary adjustments and sometimes the use of pancreatic enzyme supplements.

35. Can the Whipple procedure be performed on individuals with liver disease?

The Whipple procedure can be performed on individuals with liver disease, depending on the specific liver condition, its severity, and the overall health of the patient. It may entail a very high risk in individuals with severe liver disease and may not be advisable in this setting. The suitability of the procedure would be evaluated on a case-by-case basis in consultation with a healthcare provider specialising in liver and pancreatic surgeries.

FAQs Reviewed by Dr. Vivek Mangla, Director - Gastrointestinal and Hepatopancreatobiliary (GI & HPB) Surgical Oncology, Cancer Care / Oncology, Surgical Oncology, Gastrointestinal & Hepatobiliary Oncology, Gastro Intestinal & Hepatopancreatobiliary Surgical Oncology, Robotic Surgery on 26-Jun-2023.