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. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. 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.
  
  
• 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: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• 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: This is medicine that may be given in your IV or as a gas that you breathe. You may wear a face mask or have a tube placed in your mouth and throat. This tube is called an endotracheal tube or ET tube. Usually you are asleep before caregivers put the tube into your throat. The ET tube is usually removed before you wake up. You are completely asleep and free from pain during surgery.
  
  
• 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: Caregivers may help you get out of bed to walk on the same day of surgery, or the day after. Ask caregivers if there are exercises that you may do while in bed. Exercise helps blood move through your body and may help prevent blood clots from forming. Your caregiver will tell you when it is OK to get out of bed. Call your caregiver before getting up for the first time. If you feel weak or dizzy while standing up, sit or lie down right away and call your caregiver.
  
  
• Diet: You may be able to eat when bowel sounds are heard. Your caregiver will listen to your stomach for bowel sounds using a stethoscope. You may be given ice chips at first, and then liquids such as water, broth, juice, or soda pop. If you do not have problems after drinking liquids, caregivers may then give you soft foods. Some examples of soft foods are ice cream, applesauce, or custard. Once you can eat soft food easily, you may begin eating your usual diet.
  
  
• 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: A Foley catheter is a tube that is put into your bladder to drain your urine into a bag. The bladder is an organ where urine is kept. Keep the bag of urine well below your waist. Lifting the urine bag higher will make the urine flow back into your bladder, which can cause an infection. Avoid pulling on the catheter because this may cause pain and bleeding, and the catheter may come out. Do not allow the catheter tubing to kink because this will block the flow of urine.
  
  
• Medicines: You may need any of the following:
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called 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 control vomiting (throwing up). Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Medicine may be given regularly, or may only be given if you ask caregivers for it. Tell caregivers if your pain does not decrease enough for you to feel better. Do not wait to ask for your pain medicine until the pain is very bad. The medicine may not work as well at controlling your pain if you wait too long to take it. Ask your caregiver for help getting out of bed if you feel tired or dizzy.
    
    
  • 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 for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
    
    
  • Heart monitor: This is also called an ECG, electrocardiogram, or telemetry. Sticky pads are placed on your chest or different parts of your body. Each pad has a wire leading to a small portable box (telemetry unit), or to a TV-type screen. This lets caregivers see a tracing of the electrical activity of your heart. The heart monitor may help caregivers see problems with the way your heart is beating. Do not remove any wires or sticky pads without asking your caregiver first.
    
    
  • Intake and output: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). Certain foods also contain liquid. You may need more or less liquid each day. Ask your caregiver how much liquid you should have each day. Ask caregivers if they need to measure or collect your urine before you dispose of it.
  
  
• Oxygen: You may need extra oxygen to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. Tell your caregiver if your nose gets dry or if the mask or prongs bother you. Ask your caregiver before taking off your oxygen. Never smoke or let anyone else smoke in the same room while your oxygen is on. Doing so may cause a fire.
  
  
• Pneumatic boots: These are plastic boots or leggings put on your feet or legs over pressure stockings or ace wraps. The boots or leggings are connected to an air pump machine. The pump tightens and loosens different parts of the pneumatic boots. This helps push the blood back up to the heart to keep clots from forming.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

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.

Link to Page

Print Page

Email Page