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About Your Whipple Procedure (Pancreaticoduodenectomy)

This information will help you prepare for your Whipple procedure, including what to expect before, during, and after your surgery.

The Whipple procedure is done to remove a tumor in the head of your pancreas. Your doctor and nurse will discuss the specifics of your treatment with you.

About Your Pancreas

Your pancreas is a spongy, leaf-shaped gland that is about 6 inches long and 2 inches wide. It lies in the back of your abdomen, behind your stomach and above your small intestine (see Figure 1). The major function of your pancreas is to secrete hormones and enzymes. These hormones are insulin and glucagon, which help to keep your blood sugar levels normal. Enzymes help break down food. Your pancreatic enzymes help your body digest fat.

Although part of your pancreas will be removed during surgery, there is usually enough of it left to secrete hormones and enzymes.

  • High blood sugar level is rarely a problem after this surgery, but it can happen.
  • If your remaining pancreas does not make enough enzymes to digest the food you eat, you may have diarrhea. If this happens, you may need to take pills with meals and snacks to replace the enzymes.

Your liver makes and releases bile, which is a liquid that helps with digestion. The bile drains from your liver and goes into your common bile duct. This duct empties the bile into your duodenum (first part of your small intestine). If you have a tumor in this area, it can block the bile from being emptied. This causes jaundice (yellow skin color) and itching.

 

Your Surgery

  • To remove the tumor, the head of your pancreas, your duodenum, the end of your common bile duct, and your gallbladder will all be removed. Sometimes, part of the stomach must be removed.
  • Your surgeon will then connect the rest of your common bile duct and your remaining pancreas to your jejunum (middle part of your small intestine). This ensures that the pancreatic enzymes and bile will flow into your small intestine, as before (see Figure 2).
  • Your surgery will take about 4 hours.

Before Your Surgery

  • Your surgery can usually be scheduled to take place within 1 to 2 weeks. If you need any additional tests, your doctor's office will schedule them. You will need to have presurgical testing (PST).
  • Try to do at least 30 minutes of some kind of aerobic exercise each day. It can be walking on a treadmill, riding a bicycle, walking, or swimming. This will help with your recovery.
  • If you smoke, please tell your doctor or nurse. He or she will refer you to the Tobacco Treatment Program at MSK to help you stop smoking or discuss other options.
  • You may need to do a bowel preparation at home before your surgery. This is done to clean out your intestines before your surgery. Your nurse will give you these instructions separately.

After Your Surgery

You will wake up in the Post Anesthesia Care Unit (PACU) and spend your first night there. You will most likely have the following:

  • A tube, called a nasogastric or NG tube, in your nose going into your stomach. This tube drains the fluid that naturally collects in your stomach. This gives the fluid a way to drain to prevent vomiting. The tube is usually removed the first day after surgery. The tube may be uncomfortable
  • A Foley® catheter (thin, flexible tube) in your bladder to drain your urine. The catheter is usually taken out 3 days after surgery
  • A small drain or tube in your abdomen to remove excess fluid
  • An intravenous (IV) line in a vein in your neck or arm to give you fluids and pain medication. It will stay in until you begin drinking liquids and eating again
  • Sequential compression sleeves (SCDs) on your legs. SCDs, also called compression boots, inflate and deflate to help your blood circulate. This helps prevent blood clots. They will be removed when you are walking or when you no longer need them
  • You will likely be in the hospital for 1 week

Soon after you return to your room, your compression boots will be removed. You will be helped out of bed into a chair and then encouraged to walk a short distance with help.

Walking soon after surgery helps:

  • Improve blood flow
  • Prevent blood clots
  • Stimulate bowel function

You will also be asked to do coughing and deep breathing exercises and use an incentive spirometer. These help prevent pneumonia. For more information on using your incentive spirometer, ask your nurse for the resource How to Use Your Incentive Spirometer.

Managing your pain

You will have a patient-controlled analgesia (PCA) pump connected to your IV line or an epidural. It lets you give yourself pain medication safely when you need it. Your nurse in the PACU will teach you how to use the pump. Please speak with your doctor or nurse if your pain is not relieved. It is very important that your pain is controlled so that you can walk, cough, and breathe deeply. For more information about your PCA pump, ask your nurse for the resource Patient-Controlled Analgesia (PCA).

Diet

  • You will drink sips of clear liquids for 2 to 3 days after your surgery. You will gradually advance to a regular diet as tolerated.
  • At first, you will not be able to eat the same portions of food you did before your surgery. Try to eat 4 to 6 small meals a day.
  • If you don't have much of an appetite at first, you can try drinking a liquid nutritional supplement such as Ensure®. A dietitian will work closely with you to plan your diet before you leave the hospital. If you need to reach a dietitian after you leave the hospital, you can leave a message at (212) 639-7071. A dietitian will return your call as soon as possible.
  • If your remaining pancreas doesn't make enough enzymes to digest your food, you may have diarrhea. If this happens, you may need to take pills with your food to replace the enzymes.
  • Many patients lose weight before and after the surgery. You probably will not regain this weight for some time. The goal is to maintain your new weight.

Leaving the Hospital

  • You will be ready to leave the hospital when you can eat a regular diet, move your bowels, and show no signs of complications.
  • Your doctor will give you discharge instructions and prescriptions for any medications you will need. Your nurse will review these instructions with you and will give you a copy to keep.
  • If you need a visiting nurse to come to your home, this will be arranged before you go home.

Follow-up care

  • Your first appointment after your surgery will be 1 to 2 weeks after you leave the hospital. Please call your doctor's office to schedule this appointment.

Caring for yourself at home

The most common problems patients experience after surgery are lack of appetite and feeling full quickly. These are expected and should improve over time. Try to eat small amounts of your favorite foods throughout the day. It is important to get enough calories and prevent further weight loss.

Another common problem patients experience after surgery is fatigue, which usually lasts for 6 to 8 weeks. Some of this fatigue is related to the surgery itself and some is related to the weight you may have lost before your surgery. This will slowly improve over time. Here are some suggestions to help you increase your energy:

  • Try to increase your activity level every day to help manage your fatigue. Get up, get dressed, and walk. Try to gradually increase the distance you walk each day. You can walk up stairs.
  • You can take a nap during the day, if necessary, but try to stay out of bed as much as possible so you can sleep at night.
  • For 6 weeks after your surgery, do not lift anything heavier than 5 pounds.

You may still have some pain when you go home. If so, your doctor will give you a prescription for pain medication before you leave the hospital.

  • Take your pain medication as directed when you need it.
  • A side effect of pain medication is constipation. Drink extra liquids and use a stool softener such as docusate sodium (Colace®) and a laxative (senna), if needed. As the pain lessens, extra strength acetaminophen (Tylenol®) may be enough to control it.
  • You can start driving again when your doctor says it is okay. This will usually be about 3 weeks after your surgery. Do not drive if you are taking any pain medication that could make you drowsy.

Call Your Doctor or Nurse if You Have:

  • Chills or a temperature of 100.5° F (38.3° C) or higher
  • Redness or drainage from your incision
  • Any sudden increase in pain or new pain
  • Nausea and vomiting
  • Diarrhea
  • Constipation
  • Any new or unexplained symptom
  • Any questions or concerns