- What is a Whipple procedure?
- What are the indications of a Whipple surgery?
- Pancreatoduodenectomy step-by-step
- Postoperative period
- Side effects of the procedure
- Whipple procedure recovery
This is a radical surgical method which is mainly used for pancreatic cancer treatment if the tumour is located within pancreas head. This is a long lasting and complex surgery affecting many digestive organs.
Together with the affected pancreas the surgeon removes a part of stomach, a segment of small intestine (duodenum), gallbladder and common bile duct. Then the surgeon stitches the remaining parts of GIT (gastrointestinal tract) applying the technique which is considered as proper and reconstructs a segment of biliary tracts.
Because of depth and length of intervention, specifics of removed structures, this surgery is only performed by experienced surgeons.
What are the indications of a Whipple surgery?
Besides cancer of pancreas the Whipple procedure is provided to patients with the following diagnoses:
- malignant tumour of gallbladder;
- duodenal cancer;
- a list of particular benign neoplasms (causing serious impairment of bile excreting system);
- rare cases of chronic pancreatitis.
The main goal of pancreatoduodenectomy is a treatment of pancreatic cancer. Today it is the only surgical method to treat tumour of pancreas which is mainly performed together with chemo- and radiotherapeutic exposure. This essentially increases chances for successful treatment.
Whipple procedure is over 80 years old, from the moment of the first surgery this method has been improved by surgeons and amended with new equipment.
Thus, introduction of laparoscopic methods allowed to shorten the length of the surgery and significantly reduced injury rate with the concurrent risk of complications.
Whipple surgical procedure is performed in three steps.
Step one - diagnostic examination (revision) using laparoscope.
Visual investigation of abdominal cavity allows to study in details the degree of damage of internal organs and to evaluate the scale of planned intervention. Depending on the results of investigation a surgical team decides on the method of surgery: minimally invasive laparoscopic or classic open method. Nevertheless, during the process of laparoscopic pancreaticoduodenal resection which usually takes 4-5 hours, the surgeon can continue the surgery using open method which can last up to 10 hours.
Step two - surgery itself.
The resection is performed under general anaesthesia. The construction of digestive system, namely, strong correlation of its organs results in a situation when for the treatment of pancreatic cancer not only the damaged area of the organ should be removed but also a partial or complete resection of organs with common blood and lymph supply should be done.
Thus, the following organs have to be resected:
- a part of stomach;
- a part of biliary tract;
- lymph nodes.
Depending on the stage, size and location of the tumour, there are different variants of Whipple procedure. Moreover, if neoplastic process affected large vessels of the liver, the damaged area is also removed together with plastic reconstruction of its vessels.
The final stage of the surgery involves reconstruction of GIT to ensure its maximum effective digestive function. For this purpose the bowel is stitched to the remaining part of the gland, biliary duct and stomach. The quality of reconstruction affects not only rehabilitation period but also prognosis of cancer therapy in general.
All removed tissues and organs are sent to histological examination (test for the presence of metastases).
When Whipple surgery is finished the patient is transferred to the intensive care unit where he or she is monitored until his or her condition stabilizes. During the first day the patient receives intravenous nutrition. After severals days a soft meal can be eaten within a special diet. Step by step the menu extends according to recovery rate of digestive system.
While healing the drainage tubes installed in abdomen during the surgery for discharge outflow are removed.
Postoperative period is affected by the type of intervention. Minimally invasive laparoscopic method reduces risk of infectious complications and pains on movement.
In most cases postoperative period lasts 10 days and complete recovery should be expected at the earliest in 2 months.
Side effects of the procedure
Whipple procedure complications include:
- increased fatigue;
- pain during the first days after resection;
- digestive disorders;
- diabetes mellitus against the background of insulin deficiency;
Whipple procedure recovery
The basis for earliest recovery after pancreatoduodenectomy is strict compliance with the diet and recommendation of the attending physician. Specialists (nutritionist, endocrinologist) make an individual set of rehabilitation procedures.
Depending on expansion of malignant tumour oncologists create a plan for subsequent therapy. It can comprise, for example, a course of chemotherapy.
It is important to remember that only complex pancreatic cancer treatment can increase survival rate and give a chance for recovery.