The Whipple procedure is a major type of surgery which is done to excise the pancreatic head. It is also called pancreaticoduodenectomy.

This surgery is called the Whipple procedure named after an American surgeon called Allen Whipple who refined this procedure in 1935. He also reduced the surgery from a two-step process into a single step making it less involving. This type of surgery was, however first described in 1898 by an Italian surgeon and done in 1909 by Kusch in Germany.

Indications for the Whipple procedure are mainly destructive and sometimes well-disposed tumors of the pancreatic head. In addition, it could be done in cases of cancers of the gallbladder, the bile duct or the duodenum. The pancreas can be defined as the thin structure of leaf shape whose origin lies just behind the stomach. It contains cells whose main function is in the production of insulin and other digestive enzymes which assist in the digestion of food.

Why is Whipple procedure done?

The pancreas is a vital organ that lies in the upper abdomen, behind your stomach. It works closely with the liver and ducts that carry bile. The pancreas releases (secretes) enzymes that help you digest food, especially fats and protein.

Your doctor may recommend you have a Whipple procedure to treat:

• Pancreatic cancer
• Pancreatic Cysts
• Pancreatic tumors
• Pancreatitis
• Ampullary cancer
• Bile duct cancer
• Neuroendocrine tumors
• Small bowel cancer
• Trauma to the pancreas or small intestine
• Other tumors or disorders involving the pancreas, duodenum or bile ducts

The goal of doing a Whipple procedure for cancer is to remove the tumor and prevent it from growing and spreading to other organs. This is the only treatment that can lead to prolonged survival and cure for most of these tumors.

What is the procedure of Whipple surgery?

A Whipple procedure may be done in various ways:

• Open surgery, During an open procedure, your surgeon makes an incision in your abdomen in order to access your pancreas. This is the most common approach and the most studied.
• Laparoscopic surgery, During laparoscopic surgery, the surgeon makes several smaller incisions in your abdomen and inserts special instruments, including a camera that transmits video to a monitor in the operating room. The surgeon watches the monitor to guide the surgical tools in performing the Whipple procedure. Laparoscopic surgery is a type of minimally invasive surgery.
• Robotic surgery is a type of minimally invasive surgery in which the surgical tools are attached to a mechanical device (robot). The surgeon sits at a console (comforts) nearby and uses hand controls to direct the robot. A surgical robot can use tools in tight spaces and around corners, where human hands may be too large to be effective.

What will happen after the procedure?

• Stay in the general surgical unit, Most people will go directly to a general surgical nursing floor after surgery to recover. Nursing staff and the entire surgical team will be monitoring your progress several times a day and watching for any signs of infection or complications. Your diet will be slowly advanced as tolerated. Most people will be walking immediately after the operation. Expect to spend at least a week in the hospital, depending on your overall recovery.
• Stay in the intensive care unit (ICU) for few days. If you have certain medical conditions or a complex case, you may be admitted to the ICU after surgery. ICU doctors and nurses will monitor your condition regularly to watch for signs of complications. They'll give you fluids, nutrition, and medications through intravenous (IV) lines. Other tubes will drain urine from your bladder and drain fluid & blood from the surgical area.

What are the risks after or before Whipple surgery?

Most common surgical difficulties associated with the Whipple procedure are anesthesia complications, wherein patients could possibly lead to respiratory failure and weakness post-surgery. Other problems include those that are related to intubation - the process of inserting a tube that allows breathing during operations like trauma on the throat and the lungs.

Apart from complications associated with anesthesia and intubation, bleeding is also a major risk during and after the Whipple procedure. Moreover, this risk becomes more profound (keen) with clients belonging to religious affiliations that prohibit blood transfusion. Another risk that is present during and after the Whipple procedure is the deep vein thrombosis (infraction) or formation of clots that block the flow of blood to vital organs.

Results after the Whipple surgery:

Your chances of long-term survival after a Whipple procedure depends on your particular situation. For most tumors and cancers of the pancreas, the Whipple procedure is the only known cure.

Talk to your treatment team, family and friends if you feel stressed, worried or depressed. It may help to discuss how you're feeling. You may want to consider joining a support group of people that have experienced a Whipple procedure or talking with a professional counselor.

Whipple surgery costs minimum Rs. 3,50,000 to maximum Rs. 7,00,000.