About Your Surgery
This guide will help you prepare for your Whipple procedure (pancreaticoduodenectomy) at Memorial Sloan Kettering (MSK), and help you understand what to expect during your recovery. Read through this guide at least once before your surgery and then use it as a reference in the days leading up to your surgery. Bring this guide with you every time you come to MSK, including the day of your surgery, so that you and your healthcare team can refer to it throughout your care.
The Whipple procedure is done to remove a tumor in the head of your pancreas. Your pancreas is located in the back of your abdomen (belly) behind your stomach and above your small intestine (see Figure 1).
Your pancreas produces enzymes that help to digest fat. Your pancreas also produces 2 hormones, insulin and glucagon. They help to regulate blood sugar levels.
Although part of your pancreas will be removed during surgery, there is usually enough of it left to produce hormones and enzymes.
- If your remaining pancreas doesn’t 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.
- If your remaining pancreas doesn’t make enough insulin, you may have high blood sugar level. High blood sugar level is rarely a problem but if you do experience it, your healthcare team will help you.
During your surgery, your surgeon will remove the head of your pancreas, your duodenum (the first part of your small intestine), the end of your common bile duct, and your gallbladder. 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
The information in this section will help you prepare for your surgery. Read through this section when your surgery is scheduled and refer to it as your surgery date gets closer. It contains important information about what you need to do before your surgery. Write down any questions you have and be sure to ask your doctor or nurse.
You and your healthcare team will work together to prepare for your surgery.
- I take a blood thinner. Some examples are heparin, warfarin (Coumadin®), clopidogrel (Plavix®), enoxaparin (Lovenox®), and tinzaparin (Innohep®). There are others, so be sure your doctor knows all the medications you’re taking.
- I take prescription medications.
- I take any over-the-counter medications, herbs, vitamins, minerals, or natural or home remedies.
- I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
- I have sleep apnea.
- I have had a problem with anesthesia in the past.
- I am allergic to certain medication(s) or materials, including latex.
- I am not willing to receive a blood transfusion.
- I drink alcohol.
- I smoke.
- I use recreational drugs.
About Drinking Alcohol
The amount of alcohol you drink can affect you during and after your surgery. It’s important that you talk with your healthcare providers about your alcohol intake so that we can plan your care.
- Stopping alcohol suddenly can cause seizures, delirium, and death. If we know you are at risk for these complications, we can prescribe medication to help prevent them.
- If you drink alcohol regularly, you may be at risk for other complications during and after surgery. These include bleeding, infections, heart problems, and longer hospital stay.
Here are things you can do to prevent problems before your surgery:
- Be honest with your healthcare provider about how much alcohol you drink.
- Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea, increased anxiety, or cannot sleep after you stop drinking, tell your doctor right away. These are early signs of alcohol withdrawal and can be treated.
- Tell your healthcare provider if you cannot stop drinking.
- Ask us any questions you have about drinking and surgery. As always, all of your treatment information will be kept confidential.
People who smoke can have breathing problems when they have surgery. Stopping even for a few days before surgery can help. If you smoke, your nurse will refer you to our Tobacco Treatment Program. You can also reach the program at 212-610-0507.
About Sleep Apnea
Sleep apnea is a common breathing disorder that causes a person to stop breathing for short periods while sleeping. The most common type is obstructive sleep apnea (OSA). With OSA, the airway becomes completely blocked during sleep. It can cause serious problems during and after surgery.
Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing machine (such as a CPAP) for sleep apnea, bring it with you the day of your surgery.
Before your surgery, you will have presurgical testing (PST). The date, time, and location of your PST appointment will be printed on the appointment reminder from your surgeon’s office.
You can eat and take your usual medications the day of your PST appointment. During your appointment, you will meet with a nurse practitioner who works closely with anesthesiology staff (doctors and specialized nurses who will give you medication to put you to sleep during your surgery). They will review your medical and surgical history with you. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests necessary to plan your care. Your nurse practitioner may also recommend you see other healthcare providers.
Your nurse practitioner will discuss which medications you should take the morning of your surgery. To help you remember, we’ve left space for you to write these medications down in “The Morning of Your Surgery” section of this guide.
Bring the following with you to your PST appointment:
- A list of all the medications you are taking, including patches and creams.
- Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram (echo), or carotid doppler study.
- The name(s) and telephone number(s) of your doctor(s).
Complete a Health Care Proxy Form
If you haven’t already completed a Health Care Proxy form, we recommend you complete one now. A health care proxy is a legal document that identifies the person who will speak for you if you are unable to communicate for yourself. The person you identify is called your health care agent.
If you are interested in completing a Health Care Proxy form, talk with your nurse. If you have completed one already, or if you have any other advanced directive, bring it with you to your next appointment.
Do Breathing and Coughing Exercises
Practice taking deep breaths and coughing before your surgery. You will be given an incentive spirometer to help expand your lungs. For more information, read How to Use Your Incentive Spirometer. If you have any questions, ask your nurse or respiratory therapist.
Try to do aerobic exercise every day, such as walking at least 1 mile, swimming, or biking. If it is cold outside, use stairs in your home or go to a mall or shopping market. Exercising will help your body get into its best condition for your surgery and make your recovery faster and easier.
Eat a Healthy Diet
Eat a well-balanced, healthy diet before your surgery. If you need help with your diet talk to your doctor or nurse about meeting with a dietitian.
Stop Taking Vitamin E
If you take vitamin E, stop taking it 10 days before your surgery, because it can cause bleeding. For more information,read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).
Purchase Hibiclens® Skin Cleanser
Hibiclens is a skin cleanser that kills germs for 24 hours after using it. Showering with Hibiclens before surgery will help reduce your risk of infection after surgery. You can buy Hibiclens at your local pharmacy without a prescription.
Purchase Supplies for Bowel Preparation, if Needed
If you need to do a bowel preparation before your surgery, your nurse will tell you how. Use the area below to check off and write in any supplies you’ll need.
Magnesium citrate bowel preparation
- 1 (10-ounce) bottle of magnesium citrate
MiraLAX® bowel preparation
- 1 (5 mg) tablet of bisacodyl (Dulcolax®). These are usually sold as a box of 10 tablets.
- 1 (238 gram) bottle of polyethylene glycol (MiraLAX)
- 1 (64-ounce) bottle of a clear liquid
Stop Taking Certain Medications
If you take aspirin, ask your surgeon if you should continue. Aspirin and medications that contain aspirin can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).
Stop Taking Herbal Remedies and Supplements
Stop taking herbal remedies or supplements 7 days before your surgery. If you take a multivitamin, talk with your doctor or nurse about whether you should continue. For more information, please read Herbal Remedies and Cancer Treatment.
Watch a Virtual Tour
This video will give you an idea of what to expect when you come to Memorial Sloan Kettering’s main hospital on the day of your surgery.
Stop Taking Certain Medications
Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (e.g., Advil®, Motrin®)and naproxen (e.g., Aleve®). These medications can cause bleeding. For more information, please read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).
Drink Only Clear Liquids
You will need to follow a clear liquid diet the day before your surgery. Examples of clear liquids are listed in the table below. Your doctor or nurse will tell you if you will need an extra day of clear liquids or any additional bowel preparation. While you are on this diet:
- Do not eat any solid foods.
- Make sure to drink plenty of liquids other than water, coffee, and tea. Try to drink at least 1 (8-ounce) glass of a clear liquid every hour while you’re awake.
|Drink||Do Not Drink|
||Any products with any particles of dried food or seasoning|
Start Bowel Preparation, If Needed
If your surgeon or nurse told you that you will need to do a bowel preparation, you will need to start it 1 day before your surgery. During your bowel preparation:
- Do not eat any solid foods.
- Make sure to drink plenty of liquids other than water, decaffeinated black coffee, and decaffeinated tea. Try to drink at least 1 (8-ounce) glass every hour while you’re awake.
Magnesium citrate bowel preparation
- At 2:00 pm on the day before your surgery, drink the magnesium citrate.
MiraLAX bowel preparation
On the morning before your surgery, mix all 238 grams of MiraLAX with the 64 ounces of clear liquid until the MiraLAX powder dissolves. Once the MiraLAX is dissolved, you can put the mixture in the refrigerator, if you prefer.
The MiraLAX will cause frequent bowel movements, so be sure to be near a bathroom the evening before your surgery or procedure.
At 3:00 pm on the day before your surgery, take 1 bisacodyl tablet by mouth with a glass of water.
At 5:00 pm on the day before your surgery, start drinking the MiraLAX bowel preparation. Drink 1 (8-ounce) glass of the mixture every 15 minutes until the container is empty. When you’re finished drinking the MiraLAX, drink 4 to 6 glasses of clear liquids. You can continue to drink clear liquids until midnight, but it is not required.
Apply zinc oxide ointment or Desitin® to the skin around your anus after every bowel movement. This helps prevent irritation.
Note the Time of Your Surgery
A clerk from the Admitting Office will call you after 2:00 pm the day before your surgery. They will tell you what time you should arrive at the hospital for your surgery. If you are scheduled for surgery on a Monday, you will be called on the Friday before. If you do not receive a call by 7:00 pm, please call 212-639-5014.
Both locations are at 1275 York Avenue between East 67th and East 68th streets.
M elevator to 2nd floor
B elevator to 6th floor
Shower With Hibiclens
The night before your surgery, shower using Hibiclens. To use Hibiclens, open the bottle and pour some solution into your hand or a washcloth. Move away from the shower stream to avoid rinsing off the Hibiclens too soon. Rub it gently over your body from your neck to your waist and rinse.
Don’t let the solution get into your eyes, ears, mouth, or genital area. Don’t use any other soap. Dry yourself off with a clean towel after your shower.
Go to bed early and get a full night’s sleep.
- Do not eat anything after midnight the night before your surgery. This includes hard candy and gum.
- Between midnight and up until 2 hours before your scheduled arrival time, you may drink a total of 12 ounces of water (see figure).
- Starting 2 hours before your scheduled arrival time, do not eat or drink anything. This includes water.
Shower With Hibiclens
Shower using Hibiclens just before you leave for the hospital. Use the Hibiclens the same way you did the night before. Don’t use any other soap. Don’t put on any lotion, cream, powder, deodorant, makeup, or perfume after your shower.
Take Your Medications as Instructed
If your doctor or nurse practitioner instructed you to take certain medications the morning of your surgery, take only those medications with a sip of water. Depending on what medications you take and the surgery you’re having, this may be all, some, or none of your usual morning medications.
Things to Remember
- Don’t put on any lotions, creams, deodorants, makeup, powders, or perfumes.
- Don’t wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
- Leave valuables, such as credit cards, jewelry, or your checkbook at home.
- Before you are taken into the operating room, you will need to remove your eyeglasses, hearing aids, dentures, prosthetic device(s), wig, and religious articles, such as a rosary.
- If you wear contact lenses, wear your glasses instead.
What to Bring
- This guide. Your healthcare team will use this guide to teach you how to care for yourself after your surgery.
- Sneakers that lace up. You may have some swelling in your feet. Lace-up sneakers can accommodate this swelling.
- Only the money you may need for a newspaper, bus, taxi, or parking.
- Your portable music player, if you choose. However, someone will need to hold this item for you when you go into surgery.
- Your incentive spirometer, if you have one.
- Your breathing machine for sleep apnea (such as your CPAP), if you have one.
- If you have a case for your personal items, such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles such as a rosary, bring it with you.
- Your Health Care Proxy form, if you have completed one.
Parking When You Arrive
Parking at MSK is available in the garage on East 66th Street between York and First Avenues. To reach the garage, turn onto East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a pedestrian tunnel that you can walk through that connects the garage to the hospital. If you have questions about prices, call 212-639-2338.
There are also other garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.
Once You’re in the Hospital
You will be asked to state and spell your name and date of birth many times. This is for your safety. People with the same or similar names may be having surgery on the same day.
Get Dressed for Surgery
When it is time to change for surgery, you will get a hospital gown, robe, and nonskid socks to wear.
Meet With Your Nurse
Your nurse will meet with you before your surgery. Tell him or her the dose of any medications (including patches and creams) you took after midnight and the time you took them.
Meet With Your Anesthesiologist
- Review your medical history with you.
- Talk with you about your comfort and safety during your surgery.
- Talk with you about the kind of anesthesia you will receive.
- Answer any questions you may have about your anesthesia.
Prepare for Surgery
Once your nurse has seen you, 1 or 2 visitors can keep you company as you wait for your surgery to begin. When it’s time for your surgery, your visitor(s) will be shown to the waiting area. Your visitors should read Information for Family and Friends for the Day of Surgery.
You will either walk into the operating room or be taken in on a stretcher. A member of the operating room team will help you onto the operating bed. Compression boots will be placed on your lower legs. These gently inflate and deflate to help circulation in your legs.
Your anesthesiologist will place an intravenous (IV) line into a vein, usually in your arm or hand. The IV line will be used to give you fluids and anesthesia (medication to make you sleep) during your surgery.Back to top
After Your Surgery
The information in this section will tell you what to expect after your surgery, both during your hospital stay and after you leave the hospital. You will learn how to safely recover from your surgery. Write down any questions you have and be sure to ask your doctor or nurse.
When you wake up after your surgery, you will be taken to the Post Anesthesia Care Unit (PACU). You will stay in the PACU overnight.
You will receive oxygen through a thin tube called a nasal cannula that rests below your nose. A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels.
You will have 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, preventing vomiting. The tube is usually removed the first day after surgery. The tube may be uncomfortable.
You will have a patient-controlled analgesia (PCA) device. PCA uses a computerized pump to deliver pain medication into your IV. For more information, read Patient-Controlled Analgesia (PCA).
You will have a Foley® catheter (a thin, flexible tube) in your bladder to monitor the amount of urine you are making. The Foley should be removed 2 or 3 days after your surgery. You will also have compression boots on your lower legs to help your circulation. They will be taken off when you are able to walk.
You may have a drain in your abdomen to drain extra fluid from the area. Most of the time, the drains are removed after a few days. If you go home with a drain, your nurse will show you how to care for it.
Your visitors can see you briefly in the PACU, usually within 90 minutes after you arrive there. A member of the nursing staff will explain the guidelines to them. After your stay in the PACU, you will be taken to your hospital room in the inpatient unit. There, your nurse will tell you how to recover from your surgery. Below are examples of ways you can help yourself recover safely.
- It is important to walk around after surgery. Walking every 2 hours is a good goal. This will help prevent blood clots in your legs.
- Use your incentive spirometer. This will help your lungs expand, which prevents pneumonia. For more information, read How to Use Your Incentive Spirometer.
Will I have pain after my surgery?
Your doctor and nurse will ask you about your pain often and give you medication as needed. If your pain is not relieved, tell your doctor or nurse.
You will be given a prescription for pain medication before you leave the hospital. Pain medication may cause constipation (having fewer bowel movements than what is normal for you).
How can I prevent constipation?
- Go to the bathroom at the same time every day. Your body will get used to going at that time.
- If you feel the urge to go, do not put it off. Try to use the bathroom 5 to 15 minutes after meals.
- After breakfast is a good time to move your bowels. The reflexes in your colon are strongest at this time.
- Exercise if you can. Walking is an excellent form of exercise.
- Drink 8 (8-ounce) glasses (2 liters) of liquids daily, if you can. Drink water, juices, soups, ice cream shakes, and other drinks that don’t have caffeine. Beverages with caffeine, such as coffee and soda, pull fluid out of the body.
- Slowly increase the fiber in your diet to 25 to 35 grams per day. Fruits, vegetables, whole grains, and cereals contain fiber. If you have an ostomy or have had recent bowel surgery, check with your doctor or nurse before making any changes in your diet.
- Both over-the-counter and prescription medications are available to treat constipation. Start with 1 of the following over-the-counter medications first:
- Docusate sodium (Colace®) 100 mg. Take _____ capsules _____ times a day. This is a stool softener that causes few side effects. Do not take it with mineral oil.
- Polyethylene glycol (MiraLAX® ) 17 grams daily.
- Senna (Senokot®) 2 tablets at bedtime. This is a stimulant laxative, which can cause cramping.
- If you haven’t had a bowel movement in 2 days, call your doctor or nurse.
Will I be able to eat?
You will not be able to eat or drink anything the day of your surgery and the day after that. Two days after your surgery, you can start having sips of clear liquids. 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 find that your appetite is not good at first, you may try a supplement such as Ensure®.
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 people 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.
Your dietitian will work closely with you to plan your diet before you are discharged.
How long will I be in the hospital?
Most people are in the hospital for 7 days after having a Whipple procedure but this will depend on the exact surgery that is done.
Will I have pain when I am home?
The length of time each person has pain or discomfort varies. You may still have some pain when you go home and will probably be taking pain medication. Follow the guidelines below:
- Take your medications as directed and as needed.
- Call your doctor if the medication prescribed for you doesn’t relieve your pain.
- Do not drive or drink alcohol while you are taking prescription pain medication.
- As your incision heals, you will have less pain and need less pain medication. A mild pain reliever such as acetaminophen (Tylenol®) or ibuprofen (Advil®) will relieve aches and discomfort. However, large quantities of acetaminophen may be harmful to your liver. Do not take more acetaminophen than the amount directed on the bottle or as instructed by your doctor or nurse.
- Pain medication should help you as you resume your normal activities. Take enough medication to do your exercises comfortably. Pain medication is most effective 30 to 45 minutes after taking it.
- Keep track of when you take your pain medication. Taking it when your pain first begins is more effective than waiting for the pain to get worse.
How do I care for my incision?
The location of your incision will depend on the type of surgery you had. It is normal to have numbness of the skin below the incision because some of the nerves were cut; this sensation will lessen over time.
- By the time you are ready to leave the hospital, your surgical incision will have begun to heal.
- You and your caregiver should look at your incision with your nurse before you leave the hospital so you know what it looks like.
- If any fluid is draining from your incision, you should write down the amount and color. Call your doctor’s office and speak with the nurse about any drainage from your incision.
Change your bandages at least once a day and more often if they become wet with drainage. When there is no longer any drainage coming from your incision, they can be left uncovered.
If you go home with Steri-StripsTM on your incision, they will loosen and fall off by themselves. If they haven’t fallen off within 10 days, you may remove them.
If you go home with glue over your sutures (stitches), it will also loosen and peel off, similarly to the Steri-Strips.
Is it normal to feel tired?
Yes, feeling tired (fatigue) is common after surgery, and may last for 6 to 8 weeks. This will improve slowly over time. Try to increase your activity level every day to help manage your fatigue. Get up, get dressed, and walk. You may need a nap during the day, but try to stay out of bed as much as possible so you will sleep at night.
How will my diet change after surgery?
After your surgery, you may have a lack of appetite and feel full quickly after eating. 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 protein to prevent weight loss and promote healing.
Can I shower?
Yes, taking a warm shower is relaxing and can help decrease muscle aches. Use soap when you shower and gently wash your incision. Pat the areas dry with a towel after showering, and leave your incision uncovered (unless there is drainage). Call your doctor if you see any redness or drainage from your incision.
Do not take tub baths until you discuss it with your doctor at the first appointment after your surgery.
When is it safe for me to drive?
You may resume driving 3 weeks after surgery as long as you are not taking pain medication that may make you drowsy.
What exercises can I do?
Exercise will help you gain strength and feel better. Walking and stair climbing are excellent forms of exercise. Gradually increase the distance you walk. Climb stairs slowly, resting or stopping as needed. Ask your doctor or nurse before starting more strenuous exercises.
When can I lift heavy objects?
Check with your doctor before you do any heavy lifting. Normally, you should not lift anything heavier than 5 pounds (2.3 kilograms) for at least 6 weeks. Ask your doctor how long you should avoid heavy lifting.
When is my first appointment after my surgery?
Your first appointment after surgery will be in 1 to 2 weeks after you leave the hospital. Your nurse will give you instructions on how to make this appointment, including the phone number to call.
How can I cope with my feelings?
After surgery for a serious illness, you may have new and upsetting feelings. Many people say they felt weepy, sad, worried, nervous, irritable, and angry at one time or another. You may find that you cannot control some of these feelings. If this happens, it’s a good idea to seek emotional support.
The first step in coping is to talk about how you feel. Family and friends can help. Your nurse, doctor, and social worker can reassure, support, and guide you. It’s always a good idea to let these professionals know how you, your family, and your friends are feeling emotionally. Many resources are available to patients and their families. Whether you’re in the hospital or at home, the nurses, doctors, and social workers are here to help you and your family and friends handle the emotional aspects of your illness.
What if I have other questions?
If you have any questions or concerns, please talk with your doctor or nurse. You can reach them Monday through Friday from 9:00 am to 5:00 pm.
After 5:00 pm, during the weekend, and on holidays, please call 212-639-2000 and ask for the doctor on call for your doctor.
- A temperature of 100.4° F (38° C) or higher
- Redness or drainage from your incision
- Any sudden increase in pain or new pain
- Nausea and vomiting
- Any new or unexplained symptom
- Any questions or concerns