A Whipple’s resection is performed with the intention of obtaining complete removal of a suspected tumour, situated in the head of the pancreas. The operation is only of potential benefit if the tumour can be completely removed. It is also used for the treatment of pancreatic or duodenal trauma, or chronic pancreatitis.
An incision (cut) is made in the midline just below the ribs down to and extended a bit next to the belly button. The abdomen is checked to make sure there are no signs of tumour spread beyond the pancreas. There are variations in how the operation is performed and the stomach may be left in total or only a small portion removed. The head half of the pancreas is then cut out, leaving behind the tail half of the pancreas. The head of the pancreas is closely attached to the duodenum (first part of the small bowel after the stomach), and the bile duct coming from the liver runs through the pancreas. The duodenum and bile duct with the gallbladder are also removed. The stomach, top end of the bile duct below the liver, and tail end of the pancreas are then each joined separately to the small intestine to allow for proper digestion. If it is discovered at surgery that the tumour has spread further than was seen on the scans, and that removal of the pancreas will not remove all the tumour, then a bypass procedure may be performed. Here the bile duct and stomach are stitched to the small bowel, in order to relieve blockages, but the pancreas is not removed.
A complication of some description occurs in around 40% of patients. These complications are usually minor, and although they result in a prolonged hospital stay, usually resolve on their own.
- The most significant complications are related to leaks from any of the three major joins, particularly leaks from the join between the pancreas and the intestine.
- In up to 5% of cases complications can be more serious and result in death or a second operation.
- In the long term having a reduced amount of pancreas can cause you to become diabetic and require insulin.
- You can also develop impaired digestion of food and resultant fatty stools (steatorrhoea). This is treated with enzyme replacement capsules.
- One of these problems occurs in about a third of people in the long term.
After your consultation:
- Obtain authorization from your medical aid and book your bed for your hospital admission.
- Carefully read through pre-operative information provided.
Day before surgery:
- Do not eat/drink after 22h00, the night before your surgery, unless otherwise specified by your surgeon or anaesthetist (you should be fasting for at least 6 hours before the procedure for solids but you are allowed to take clear liquids up to two hours before your procedure).
Day of surgery:
- Arrive for admission at indicated time on ‘Code & Consent’ sheet.
- Change into theatre attire, remove all valuable belongings.
This is a very long and complex procedure and can be quite variable in length. It is usually at least 6-7 hours in duration.
Duration of hospital stay:
- If everything goes smoothly the usual stay is 7-14 days. However, if there are any complications such as a leak from the pancreas the stay may be longer.
- You can start walking straight away, but it is likely to be several weeks before you are back to full strength and activity.
Back to work:
- You should expect to be off work for at least 4 to 6 weeks depending on the recovery and whether complications occurred.
Some pain and discomfort post operatively may be expected following any operation, but the following measures are used to lessen the pain experienced:
- Warming devises in theatre as well as warm intravenous fluids.
- Intra-operative pain medication through the drip.
- Post-operative medication through the drip, please inform the nurses if you are in pain so that medication will be administered to you.
- As close to one week after discharge as possible. Please contact the rooms to schedule an appointment.