Whipple procedure (pancreaticoduodenectomy)

The Whipple Procedure, or pancreaticoduodenectomy, is the most commonly performed surgery to remove tumors in the pancreas.  In a standard Whipple procedure, the surgeon removes the head of the pancreas, the gallbladder, part of the duodenum which is the uppermost portion of the small intestine, a small portion of the stomach called the pylorus, and the lymph nodes near the head of the pancreas.  The surgeon then reconnects the remaining pancreas and digestive organs so that pancreatic digestive enzymes, bile, and stomach contents will flow into the small intestine during digestion.  In another type of Whipple procedure known as pylorus preserving Whipple, the bottom portion of the stomach, or pylorus, is not removed.  In both cases, the surgery usually lasts between 5-8 hours.

After a Whipple procedure, the most common complication is delayed gastric emptying, a condition in which the stomach takes too long to empty its contents.  Usually, after 7-10 days the stomach begins to work properly.  If delayed gastric emptying persists, supplemental feedings by a feeding tube may be started.  The condition usually lasts for another 7-10 days, but could last as long as a few weeks.  The most serious potential complication is abdominal infection due to leakage where the pancreas has been connected to the intestine.  This occurs in approximately 10% of patients and is usually managed by a combination of draining tubes, antibiotics, and supplemental tube feedings.  Patients who have undergone the Whipple procedure may experience long-term effects including digestive difficulties.

The Pancreatic Cancer Action Network would like to thank Kathleen Wagner and support from the Hamill Foundation and the Pickelner Fund for Pancreatic Cancer Research at MD Anderson Cancer Center for the illustrations provided on this page.

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