The Whipple Procedure

Your Health Care Team

Your health care team for pancreatic surgery consists of Thomas VanderMeer, MD, Ali Ghellai, MD, other physicians, nurses, physical therapists, respiratory therapists and other hospital staff. Working together, these people will provide the services necessary for a successful surgery and recovery.

The Pancreas

The pancreas has two functions: it makes juices that aid in digestion and it produces insulin, which controls blood sugar. After a Whipple procedure, digestive juices continue to empty into the intestine, and the remainder of the pancreas may produce enough insulin to regulate your system. In some cases, treatment may be necessary to control blood sugar after surgery. Diabetics will need to have their medications adjusted after a Whipple procedure.

The Diagnosis

Tumors in the pancreas and surrounding area are often discovered because a patient notices that her eyes and skin are yellowed. This yellowing – jaundice – is caused by blockage of the bile duct. Darkening of the urine and lightening of the stools is also associated with jaundice, and abdominal pain may or may not be present. One or more CT scans of the abdomen are performed to evaluate pancreatic tumors.

What is a Whipple procedure?

A Whipple procedure is an operation in which the upper portion of the pancreas (the head) is removed. This may be necessary if a tumor has developed in the pancreas, bile duct or duodenum (the first part of the small intestine). This procedure may also benefit someone whose pancreas has been injured by chronic pancreatitis.

During a Whipple procedure, a portion of the bile duct, duodenum, gallbladder and sometimes a part of the stomach are removed in order to remove the head of the pancreas, which is attached to the bile duct and duodenum. The pancreas, bile duct and stomach are sewn to the intestine to allow for proper digestion of food (Figure 2). The bile duct, a tubular structure that carries bile (important for digestion of food and excretion of toxins) from the liver to the duodenum, is sewn to the intestine during a Whipple procedure and bile flow is re-established into the intestine.

The Surgery

The day before surgery, the patient will be started on a clear liquid diet. A bowel preparation will be given at home to cleanse the colon. No food or liquids should be taken after midnight. Medications should be taken with a sip of water on the morning of surgery. Your surgeon will give you specific instructions about your medications during your office visit.

You will be admitted to the hospital on the morning of surgery. The operation takes 6-8 hours to complete. The surgeon will meet with your family in the waiting room after the operation, and your family will be notified when you are moved from the Recovery Room to the Intensive Care Unit (ICU). Your family can visit you in the ICU. On the morning following surgery, you will be moved to a regular hospital bed.

After a Whipple procedure, patients stay in the hospital about ten days. The need for further treatment such as chemotherapy and radiation varies. This decision is based on information obtained by microscopic evaluation of the tumor, consultation with oncologists at the Guthrie Cancer Center, and the wishes of each individual patient.

There is a moderate amount of discomfort the first two days after surgery, but every effort will be made to minimize it. An epidural, similar to the type used in childbirth, may be administered if the anesthesiologist feels that this is appropriate. Alternatively, you have the option to give yourself pain medicine by pushing a button on a device called a PCA (Patient Controlled Analgesia). Your pain control will be monitored closely by your nurses and physicians.

Your Diet

You will not be given anything to eat or drink for several days after surgery. Fluids will be given through an intravenous catheter. A nasogastric (NG) tube will be placed in your nose during surgery and left in place for a few days. The NG tube drains juices out of the stomach and allows proper healing of the internal surgical sites. While your intestines recover from the surgery, you will not pass gas or have any bowel movements for a number of days. This is normal. When the intestines have recovered sufficiently that you begin to pass gas, you will be given liquids to drink. Your intestinal function will be monitored closely to determine the proper time to resume solid foods.

Digestion is affected by a Whipple procedure. Initially, you will need to eat small amounts frequently throughout the day – about six small meals. You will find that certain foods are easier to digest than others. The operation affects everyone’s digestion differently and, with your doctor’s help, you will find what foods work best for you – medication is often required to help with digestion. Most people experience a loss of appetite and taste, many notice a metallic taste to their food. These changes take about four to six weeks to resolve. During this time most people will lose between 10-20 pounds. Normal eating patterns resume after about eight weeks.

Getting Back on Your Feet

Resuming activity after surgery is an important part of the recovery process. Your nurses will help you get out of bed beginning the morning after surgery. They will help you manage your IV pole and tubes while you walk. A number of tubes will be used to aid in the healing process, all but one of which will be removed prior to discharge. One thin tube that is used to drain the pancreas will remain for eight weeks following surgery. This tube is coiled and placed under a dressing until it is removed.

Going Home

You will be discharged when you are able to tolerate a regular diet and have regained sufficient strength, but the recovery process does not end with discharge – it continues for up to three months, at which time most patients report that their energy levels have returned to normal. Until then, you will feel weak and tired and will require naps during the day. Your concentration and memory may temporarily be diminished, and you may even feel depressed. All these symptoms will resolve with time. For six weeks after surgery, you should not lift anything heavier than a bag of groceries in order to prevent a hernia from developing in your incision. You may climb stairs, and you may resume driving when you are no longer taking pain medication and can quickly depress the brake pedal.

Your surgeon will review your medications with you following surgery and give you instructions about which ones to resume. Additionally, you will be given a special prescription for pain medication. Showering can be resumed when you go home, but you should not soak in a tub until your pancreatic drain is removed. A ridge will develop around your incision, which is normal and will flatten with time. Some leakage of fluid is normal. If the fluid is cloudy or foul-smelling, contact Dr. VanderMeer’s office immediately. The incision will fade over the next few months.

Notify Dr. VanderMeer’s office immediately if you notice any of the following:

Fever (101 F or higher) or chills
Worsening abdominal pain
Nausea or vomiting
Diarrhea
Redness around or drainage from your incision

About Dr. VanderMeer

Thomas VanderMeer, MD, is board-certified in general surgery and specializes in complex operations of the pancreas, liver and bile duct. Dr. VanderMeer received his medical degree from the Medical College of Virginia and completed residency training in general surgery at the University of Massachusetts and Harvard Medical School. He obtained intensive fellowship training in surgery of the pancreas, liver, and bile ducts at Toronto General Hospital, the largest center for this type of surgery in North America. He was recruited to the Guthrie Clinic to provide expertise in these types of surgery to the people of the Twin Tiers. Since joining Guthrie Clinic, Dr. VanderMeer has performed a large number of Whipple procedures with results that are among the best in the country. Click here to see Dr. VanderMeer's physician profile.

About Dr. Ghellai:

Ali Ghellai, MD, is a general surgeon who undertook fellowship training in advanced hepatopancreatobiliary surgery and transplantation at the University of Rochester School of Medicine and Dentistry, where he was also a clinical instructor. Dr. Ghellai earned his medical degree from Alfatah University School of Medicine in Tripoli, Libya. He completed an internship in general surgery at Boston University School of Medicine, and a residency in general surgery at University of Massachusetts Medical School in Worcester. He completed doctorate-level courses in wound healing, cell biology, biochemistry and more at the Boston University School of Medicine, and was a research fellow in gastrointestinal surgery at the same institution. Dr. Ghellai has completed a number of advanced postgraduate clinical courses and he researches, publishes and presents regularly. He is a candidate member of the American College of Surgeons and the Society of American Gastrointestinal Endoscopic Surgeons.

Click here to see Dr. Ghellai's physician profile.