We know that undergoing any procedure is a scary experience. We understand the worry and anxiousness that is associated with surgeries and procedures and aim to walk the road to recovery with you every step of the way. We put this information together using the very helpful handbook, ‘Handbook of Surgical Consent” from Rajesh Nair and David J. Holroyd. We hope that the following information will answer all your questions and help you with the preparation phase for your procedure.
The Whipple procedure is a major surgical operation most often performed to remove cancerous tumours off the head of the pancreas. It is also used for the treatment of pancreatic or duodenal trauma, or chronic pancreatitis.This is called a Whipple’s operation after the surgeon who made the procedure popular.
A Whipple’s operation involves removing part of your pancreas, your duodenum (the first part of your small bowel), a small portion of your stomach, your gall bladder and part of your bile duct. A sufficient part of your pancreas will be left behind, you should therefore not need to take insulin after the operation. The remaining organs are reattached to allow you to digest food normally after surgery.We will monitor your digestion and blood sugar to make sure you can manage on your own. Getting over this type of surgery is hard work. It will take time to get back to eating normally. A Whipple’s operation is long operation that may take anything between 6 and 12 hours to perform. Most patients will either go to an intensive care unit or high care unit following the operation. The operation may be performed through a 12-15cm incision in the abdominal wall called an ‘open approach’ or through five smaller incisions with a camera and long instruments called ‘minimally invasive surgery’. The choice of which approach we use depends on patient factors and the underlying disease process.
When resection of the tumour in not possible
Sometimes it is not possible to remove the cancer, even though your specialist thought resection was possible based on the scans.
This could be because the cancer has grown around the major blood vessels surrounding the pancreas, or because the cancer has spread to the liver. These findings are not always seen by looking at scans and X-rays.
In cases when the surgeon finds it not possible to resect the cancer then a bypass is performed. There are two parts generally to a bypass, which are performed at the same operation. A ‘biliary bypass’ is when the surgeon can cut the bile duct above the blockage and can reconnect it to the intestine. This bypass nearly always means that you will not become jaundiced again.
Sometimes the duodenum can become blocked by the cancer and so to prevent this from happening the surgeon can attach the small bowel directly to the stomach. This allows food you are digesting to pass through the bowel. This ‘gastric bypass’ nearly always means that you will not experience extreme vomiting which is a symptom of the duodenum becoming blocked.
This operation does not offer any chance of a cure but may enable you to live a life with better quality and less symptoms of your cancer.
A complication is something that happens after surgery that makes your recovery more difficult. Chest infections or blood clots are both common complications after any surgery.
All these operations are major surgery and involve certain risks. Make sure you discuss the possible complications with your surgeon and ask all the questions you need to ask. It is important that your family members are given the chance to talk things through with the surgeon as well.The most common complications and the percentage of patients who develop them are:
- Bleeding 5%: You may have bleeding shortly after your operation because a blood vessel tie is leaking or because your blood is not clotting properly. Bleeding in a few days following surgery can occur because there is infection or a leak from your pancreatic join to the intestine. The manner in which the bleeding episode is treated depends on what is causing it.
- Leak or fistula 10-15%: A ‘fistula’ is an opening. In this case, it means that part of the internal stitching to the digestive system has come apart or broken down. This results in some of the digestive juices being able to get into your abdomen. Drains put in during the operation will be left in until the fistula dries up. The fistula then usually heals on its own. Sometimes surgery is needed to repair the leak or fistula.
- Infection 25%: Infection can develop because there is blood or tissue fluid collecting internally around the operation site or because there is internal bleeding. If you develop an internal infection, you will be given antibiotics through your drip. Abscesses or any fluid that has collected internally will need to be drained. Draining the abscess is performed usually by putting in a drainage tube. The needle or tube is guided into place with X-ray or ultrasound.
- Chest infection: Is a common complication of many operations. It happens because you are not moving around enough or breathing deeply enough after your surgery. What you would normally cough up stays in your lungs and becomes a focus for infection. You can help prevent this by doing your deep breathing exercises. The physiotherapists and nurses will get you up as soon as possible to help you get moving. You will have had heart tests before your surgery, but these are very big operations and do increase the strain on your heart.
- Heart Problems: Some people develop heart problems after surgery that weren’t evident before the operation. Complications after surgery can be very serious. They are becoming less common as more of these operations are done in specialist centres.
Nonetheless, as many as 5-9% of people who have this major surgery die directly as a result of complications after their operation.
- It is seldom necessary for blood transfusions during this type of surgery despite its magnitude. When there is blood loss during the surgery, the blood gets suctioned into a bag which is connected to the cell-saver machine. That blood is then filtered and can be given back to you. In this way we can limit the amount of blood transfusions that we may have to give with the added advantage that it is your own blood. It may however still be necessary to give you blood if the blood loss is severe.
- Please inform your surgeon if you cannot receive blood transfusions due to religious or medical reasons. Please also inform your surgeon if you have had any previous reactions to any prior blood transfusions.
- General anaesthesia.
- You will be asked to book a follow-up appointment to come back to see your surgeon when you leave the ward.