Pancreaticoduodenectomy

WHAT YOU SHOULD KNOW:

• Pancreaticoduodenectomy is also called Whipple procedure. It is done to remove a tumor (lump) from the pancreas or bile duct. A pancreatic or bile duct tumor forms when cells become cancer. The cancer cells grow and divide without control or order. These cancer cells often make too much tissue and affect other nearby structures in the abdomen (stomach). The pancreas is an organ behind the stomach which helps digest food by making digestive enzymes (chemicals). The pancreas also makes hormones, such as insulin and glucagon, which help to balance blood sugar. The pancreatic duct joins the bile duct as both ducts drain into the duodenum (upper part of small intestine).
  
  
• During the Whipple procedure, the gallbladder, duodenum, bile duct, and head of the pancreas may be removed. Sometimes, the pylorus (end part of the stomach) and lymph nodes may also be taken out. Enough of the pancreas is left to produce digestive juices and insulin. The small intestine will be attached to the stomach and to the remaining bile duct and pancreas. You and your caregiver will decide if this type of procedure for your disease is right for you. With Whipple procedure, the pancreatic or bile duct cancer may be removed, and the symptoms it causes relieved.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• Problems may happen during your Whipple procedure that may lead to more procedures. Your pancreas, stomach, small intestines, and other organs, blood vessels, or nerves may get injured while having the procedure. You could have trouble breathing, an infection, or too much bleeding after the procedure. You may have leaking of bile and other digestive juices in the abdomen, or problems absorbing food and nutrients. Sometimes, a fistula (abnormal connection between organs) may form or you may have diabetes (high blood sugar level). Even after having a Whipple procedure, there is a chance that your tumor may spread or not be completely removed.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• Without treatment, your tumor may grow and spread to other structures near it. If this happens, there is a danger that the bile ducts, blood, or nerve supply may be blocked. You may have jaundice (yellowing of the skin and the whites of the eyes) and obstruction inside the abdomen. This may lead to other serious medical problems, such as ascites (too much fluid in the abdomen) or organ failure. Organ failure means your body organs cannot work well enough to get oxygen to the cells of your body. Ask your caregiver if you are worried or have questions about your procedure, medicine, or care.

WHILE YOU ARE HERE:

Before your procedure:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.
  
  
• General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
  
  
• Endotracheal (ET) tube: An endotracheal tube may be put into your mouth or nose. It goes down into your windpipe to help keep your airway open and help you breathe. It may be hooked to a ventilator (breathing machine), and you may get extra oxygen through your ET tube. You will not be able to talk while the ET tube is in place.

During your procedure:

• Soap, water, and antiseptics (germ-killing liquids) will be used to clean your abdomen. The hair on your chest, abdomen, and genital area may be shaved. Sheets will be put over you to keep the procedure area clean. A catheter may be inserted to drain your urine. Special tests may be done to measure the flow of bile, digestive juices, or blood during the procedure. These tests may include an endoscopic ultrasound, magnetic resonance imaging (MRI) scan, or computerized tomography (CT) scan.
  
  
• During the procedure, a large incision (cut) is made in the middle portion or right upper side of the abdomen. The duodenum, gallbladder, and a portion of the bile duct and pancreas are removed and sent to the lab for tests. The small intestine is attached to the stomach and to the remaining bile duct and pancreas using sutures (threads). At the end of the procedure, a gastrostomy or jejunostomy tube is placed. Thin rubber tubes may also be placed to drain fluid coming from the incisions. The incisions are then closed by sutures or surgical tapes and covered with bandages to control bleeding.

After your procedure:

You may be taken to a recovery room until you are fully awake. Caregivers will watch you closely for any problems. Do not get out of bed until your caregiver says it is OK. When caregivers see that you are OK, you will be taken back to your hospital room. The bandages used to cover your stitches keep the area clean and dry to prevent infection. A caregiver may remove the bandages soon after your procedure to check your wound. Ask your caregiver for more information about ways to prevent bleeding and take care of your incision and tubes.

• Activity: You may need to walk around the same day of surgery, or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your caregiver says you can. Talk to caregivers before you get up the first time. They may need to help you stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call light button to let caregivers know you need help.
  
  
• Food and drink after surgery: You will able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft food easily, you may slowly begin to eat solid foods.
  
  
• Drains: These are thin rubber tubes put into your skin to drain fluid from around your incision. The drains are taken out when the incision stops draining.
  
  
• Foley catheter: This is a tube caregivers put into your bladder to drain your urine into a bag. Keep the bag below your waist. This will help prevent infection and other problems caused by urine flowing back into your bladder. Do not pull on the catheter, because this may cause pain and bleeding, and the catheter could come out. Keep the catheter tubing free of kinks so your urine will flow into the bag. Caregivers will remove the catheter as soon as possible, to help prevent infection.
  
  
• Medicines: You may need any of the following:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Anti-itching medicine: Caregivers may give you medicine to help keep your skin from itching. This medicine may be given in an IV, as a shot, by mouth, or as a skin lotion. Sometimes this medicine can make you sleepy.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    
    
    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
    
    
  • Vitamins and special formulas: Vitamins may be given to make sure you are getting enough nutrition. Special formulas, that have easy-to-digest fats, may also be given to you.
  
  
• Monitoring: Caregivers may check for your pulses on your arms or wrists. This helps caregivers learn if you have problems with blood flow after your surgery. You may also have any of the following:
  
  
  • Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
    
    
  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
    
    
  • Intake and output: Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.
  
  
• Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.
  
  
• Pneumatic boots: Inflatable boots are put on your legs. The boots are connected to an air pump. The pump tightens and loosens different areas of the boots. This helps improve blood flow to prevent clots.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Pancreaticoduodenectomy (Inpatient Care)