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.

Getting Ready

The week before your procedure:

  • Ask a family member or friend to drive you home after your procedure. Do not drive yourself home.

  • Ask your caregiver before using any over-the-counter or herbal medicine or supplement. If you regularly use these medicines or supplements, tell your caregiver.

  • Ask your caregiver if you need to stop using any of your present medications. These may include aspirin, ibuprofen, or blood thinners.

  • A procedure may be done before your Whipple procedure to place a stent in your pancreatic ducts. This may be done so that bile can continue to flow through the ducts, which will help prevent jaundice (yellowing of the skin).

  • You may need to have a computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, or an endoscopic ultrasound. You may also need other tests, such as endoscopic retrograde cholangiopancreatography (ERCP), electrocardiogram (ECG), chest x-ray, and blood tests. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

  • Your caregiver may suggest that you receive hormone-like medicines. These medicines may help decrease your chance of having further problems after surgery. Ask your caregiver for more information about these medicines.

The night before your procedure:

  • Ask caregivers about directions for eating and drinking.

  • Your bowel may need to be emptied and cleaned out before the procedure. Caregivers may give you a liquid medicine called an enema. This will be put into your rectum (rear end) to help empty your bowel. Your caregiver will teach you how to do this.

  • You may be given a pill to help you sleep.

The day of your procedure:

  • Write down the correct date, time, and location of your surgery.

  • Ask your caregiver before taking any medicine on the day of your procedure. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.

  • Do not wear contact lenses on the day of your procedure. You may wear glasses. Wear socks to help you stay warm.

  • If you are staying in the hospital after your procedure, bring your personal belongings with you. These include your bathrobe, toothbrush, denture cup (if needed), hairbrush, and slippers.

  • Caregivers will insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.

  • An anesthesiologist may talk to you before your procedure. This caregiver may give you medicine to make you sleepy during your procedure.

  • You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do the procedure. It also explains the problems that may happen, and your choices. Be sure all your questions have been answered before you sign this form.

Treatment

What will happen:

  • You may be given medicine to help you relax or make you drowsy. You will be taken on a cart to the operating room and then moved into a special bed. The area around your abdomen will be cleaned with soap and water. Sheets will be put over you to keep the procedure area clean. A catheter may be inserted to drain your urine. Caregivers will give general anesthesia to keep you completely asleep. An endotracheal tube (ET) connected to a breathing machine may also be put into your mouth or nose. The tube is used to keep your airway open and help you breathe during your procedure.

  • During the Whipple procedure, a large incision (cut) will be made in the middle portion or right upper side of the abdomen. The duodenum, a portion of bile duct and pancreas, and the gallbladder are removed and sent to the lab for tests. Your caregiver will then attach the small intestine to the stomach and to the remaining bile duct and pancreas. At the end of the procedure, a gastrostomy or jejunostomy tube may be placed. This tube is used to give liquids, food, or medicine, and let air or fluids out of your stomach. Thin rubber tubes may also be placed to drain fluid coming from the incisions. The incisions are then closed by sutures (threads) 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.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

  • You cannot make it to your appointment on time.

  • You have a fever.

  • You have questions or concerns about your procedure.

Seek Care Immediately if

  • You have nausea (upset stomach) or vomiting (throwing up).

  • You have a sudden severe abdominal pain.

  • You have trouble seeing, breathing, speaking, or thinking clearly.

  • You passed out or had a seizure (convulsion).

  • Your jaundice is increasing.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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.

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