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The Whipple operation is an operation to remove the head of the pancreas, along with the duodenum, a portion of the bile duct and the gallbladder. This operation also removes a portion of the stomach. After removal of these structures the remaining pancreas, bile duct and the stomach is then stitched back into the intestine to reconstitute the continuity of the digestive tract.

There is an alternative form of Whipple operation called the Pylorus-Preserving Pancreaticoduodenectomy or PPPD where the entire stomach is preserved and not removed. PPPD is said to allow better long-term digestive function and better quality of life.

Whipple1 Whipple2
The parts that are resected (removed) How the parts are joined back together (reconstruction)

Images courtesy of Dept of General Surgery, University of Heidelberg, Germany

The Whipple operation is named after Allen Whipple who described this operation in a publication in 1935.

This is a very complex operation. Up till the 1980s, the mortality rate (chance of dying) of this operation can be as high as 25%. This means that one out of 4 patients who had this operation may die from the operation.

However, mortality rates of the Whipple operation have seen a significant reduction since. Many centres would report a mortality rate of less than 5% nowadays. Some of the factors contributing to this improvement include refinements in surgical techniques, better understanding of pancreatic diseases, advances in diagnostics, better patient selection and improvements in perioperative care.

Another important development is the emergence of high-volume centres (defined as hospitals which perform > 10 Whipple procedures per year). Mortality and morbidity rates have been shown to be lower when the operation is performed at such high-volume centres. Such centers tend to boast larger facilities, and therefore have a broader range of specialists and technology-based services, with better-staffed intensive care units. This may also imply that complications are better recognized and managed

Nexus Surgical Disgestive Disease Centre is able to perform both the Whipple operation as well as the PPPD.

This operation is performed under general anaesthesia. In addition, the anaesthetist may place an epidural catheter for epidural analgesia. This provides excellent pain relief following the surgical operation.

General information about the Whipple operation

Your surgeon will assess your general health status. Blood tests, chest X-ray and electro-cardiogram (ECG) may be done if needed. The purpose of these tests is to ensure that you are healthy and fit enough to proceed with the operation under general anaesthesia.

You may be admitted one day before the operation. However, for selected patients, based on their general conditions, they need just come to the hospital on the day of their operation.

Just remember that you cannot eat or drink anything for 6 hours before the operation.

Your anaesthetist will put you to sleep first before we start. You will have a catheter placed into your bladder to drain the urine. A tube will also be placed through one of your nostril into the stomach to empty the stomach.

The operation is broadly divided into 2 phases:

Phase 1 – phase of resection.
Resection or the surgical removal of the diseased tissues involved the surgeon dissecting out and removing the tissues as mentioned above.

Phase 2 – phase of reconstruction.
During this phase, the surgeon will re-establish the digestive tract by suturing the small intestine to the ends of the pancreas, bile duct and stomach. The point where the surgeon surgically joined two structures together is called anastomosis (see image).
 

Whipple3
Image courtesy of the Dept of Surgery, University of Heidelberg, Germany

There are 3 anastomoses to construct:
a.    Pancreatico-enteric anastomosis: where the pancreas is stitched to the intestine
b.    Hepatico-enteric anastomosis: where the bile duct is stitched to the intestine
c.    Gastro-enteric: where the stomach is stitched to the intestine

Depending on the condition, the entire operation may last from 6 hours to 10 hours.

If the tumour is stuck to major blood vessels, like the portal vein, and there is a need to remove the vein as well, we will activate Dr Lee, our own Vascular Surgeon, to perform the vascular reconstruction.

The patient will be nursed in the High Dependency ward or even the ICU for one or two days.

The patient will have a nasogastric tube and a urine catheter. In addition, there will be one to two surgical tubes placed into the abdomen to remove any residual fluid or blood. The patient will not be allowed to eat for a couple of days. Intravenous fluid will be given to the patient for hydration as well as nutrition.

You are encouraged to be as active as possible. Whilst in bed, you may turn any way that is comfortable. Do frequent calf and leg exercises by pointing your toes back towards your knee and then pointing them towards the foot of the bed. Repeat this 10 times every hour if possible. This exercise prevents deep vein thrombosis. You will need to cough and do deep breathing exercises. This will reduce your risk of getting a chest infection.

The average length of stay following a Whipple procedure is 10 to 14 days. However the length of stay may vary in individuals. If there are any complications, the length of stay will be prolonged.

Some of the risks associated with the Whipple operation can be read here.

You can read more about how to care for yourself following your discharge from the hospital after a surgical operation by clicking here.

An appointment date will be given to you to return for a follow up consultation, usually in about a week.
Please contact your Nexus Surgical surgeon at our 24-hr hotline (+65 6333 5550) if you experience the following:

  • Fever more than 38oC
  • Severe pain and redness at the wound site
  • Discharge from the incisions such as pus and excessive bleeding
  • Jaundice (yellowing of skin)
  • Severe abdominal pain and bloating

 

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