The Whipple procedure (also called a pancreatico- duodenectomy) was first described by Allan Whipple in the 1930s. It involves removing the head of the pancreas, part of the bile duct, the gallbladder, the duodenum (the first part of the small intestine), and sometimes a portion of the stomach. After the removal of these structures, the surgeon reconnects the remaining pancreas, bile duct, and intestine.
During the 1960s and 1970s, the mortality rate for this complicated procedure was very high (about 25%). Today, the mortality rate has decreased (less than 5% in hospitals that perform the procedure frequently and about 15-20% in hospitals that perform it infrequently). If there are no Whipple procedure complications, the average hospital stay is 14 days.
Whipple Procedure Complications
If the surgeon has limited experience with this complex operation, the chances of developing complications are high. If the surgeon is experienced, the risks of developing problems are usually very low. Complications can include:
Leaking Pancreatic Juice
The pancreas is a soft organ. Because of this, the suture line (from reconnecting it) may not heal very well. This can cause pancreatic juice to leak out. Usually a catheter is placed to catch the drainage. In most patients who have this complication, the leakage heals on its own.
Delayed Bowel Function
After the procedure, bowel function must be returned to normal. The patient will go without eating or drinking for about the first 5 to 6 days (while receiving intravenous fluids) and, if bowel function is returning as expected, he or she will slowly progress to a regular diet. Most people regain complete bowel function after a few days. However, some can take up to 4 to 6 weeks to fully recover. If this was to occur, nutrition is normally obtained through a feeding tube.
Decreased Pancreatic Enzymes
The pancreas is responsible for producing enzymes that are needed to digest food. Some people may not be able to produce a sufficient amount of these enzymes after the Whipple procedure. This can affect the absorption of nutrients and cause the person’s stool to be diarrhea-like and very oily. If this was to occur, pancreatic enzyme supplementation is needed.
On average, patients lose about 5 to 10% of their pre-operative body weight after the procedure. Most are able to regain it once they are able to eat regularly.
Developing diabetes is possible since the pancreas contains insulin-producing cells. However, if the person had normal blood sugar prior to the operation, this Whipple procedure complication is unlikely.
Mayo Clinic: Pancreatic Cancer - Whipple Procedure -
University of Southern California, Department of Surgery: Whipple Operation - https://www.surgery.usc.edu/divisions/tumor/pancreasdiseases/web%20pages/pancreas%20resection/whipple%20operation.html
Image courtesy of https://commons.wikimedia.org/wiki/File:Pancreas_nih.jpg