Whipple procedure at NewYork-Presbyterian
Whipple procedure at NYPThe Whipple procedure (pancreaticoduodenectomy) is a common and potentially life-saving surgery used to treat pancreatic cancer. It is a complex procedure for extracting tumors near or in the head of the pancreas. The surgery removes the tumor in addition to the first part of the small intestine, the gallbladder, and the bile duct, and reconstructing a part of the gastrointestinal tract. The goal of the Whipple procedure is a targeted removal of cancer while maintaining the normal function of the pancreas and biliary tree, resulting in a cure or longer-term survival rates with normal gastrointestinal function and flow.
You should ask a specialist if you might be eligible for this type of pancreatic cancer surgery, as it is currently the only potential cure for cancer confined to the head of the pancreas. NewYork-Presbyterian is home to some of the best surgeons in the country to perform this complex operation.
A patient may be eligible for the Whipple procedure if the tumor:
- Is localized in the head of the pancreas.
- Has not spread to other parts of the body.
- Can be removed without causing damage to major vascular vessels.
- The patient is in good overall health.
What happens during the Whipple procedure?
What happens during the Whipple procedure?The Whipple procedure removes the head of the pancreas and attached organs, including part of the stomach, gallbladder, duodenum (C-shaped section of the small intestine), and bile duct. The surgery can take 5 to 8 hours on average, up to 12 hours for complex cases.
Steps in the Whipple procedure can include:
- Diagnostic laparoscopy. Before the procedure, your surgeon may make several small cuts in the abdomen and insert a small video camera to see if the cancer has spread beyond the pancreas. If the cancer has spread, the surgeon may decide not to continue.
- Large abdominal incision. If the cancer has not spread, the surgeon will make a larger incision in the abdominal wall and begin the procedure.
- Removal of the head of the pancreas, your duodenum, the end of your common bile duct closest to your duodenum, and the gallbladder. Part of your stomach may also need to be removed.
- Gastrointestinal reconstruction. After the organs are removed, your surgeon will reconnect the remaining common bile duct and pancreas to your jejunum, the middle segment of the small intestine, between the duodenum and the ileum. This will allow pancreatic bile and enzymes to once again flow into your small intestine.
How do I prepare for my Whipple procedure?
How do I prepare for my Whipple procedure?Before your Whipple procedure, you’ll attend a presurgical testing (PST) appointment within 30 days before your scheduled surgery. Your doctor will review your medical and surgical history, go over your list of current medications, and perform tests such as:
- A chest X-ray
- An electrocardiogram (EKG)
- Blood tests
Your specialist may recommend the following to prepare for pancreatic surgery:
- Maintaining an exercise routine and a healthy diet to help with a speedier recovery
- Abstaining from smoking
- Abstaining from drinking alcohol
- Taking certain medications before surgery, including stool softeners/laxatives, antibiotics, or pancreatic enzymes if you are experiencing digestive issues
- Stopping certain medications, including aspirin, ibuprofen, naproxen, and multivitamins, in the weeks/days leading up to your surgery
In the 24 hours before your surgery, your doctor may ask you to follow these general pre-operative guidelines:
- No eating after 12 am (midnight) the night before your procedure
- Limited beverages. From 12 am (midnight) to 2 hours before your surgery, you will only be allowed to drink water, a sports drink such as Gatorade, plain black coffee or tea, or clear apple, grape, or cranberry juice. Some doctors will limit you to these drinks for the entire day before your procedure
- No beverages or food 2 hours before your arrival time at the hospital
Once you arrive at the hospital, your care team will guide you through final preparations before surgery begins, including:
- IV placement. Once at the hospital, an IV will be placed in your arm to provide fluids and medication to prevent nausea and pain during and after the procedure
- General anesthesia will be administered once you are in the operating room
- A breathing tube will be placed down your windpipe once you are asleep and removed before you awake
What is recovery like after a Whipple procedure?
What is recovery like after a Whipple procedure?Recovery after a Whipple procedure typically involves a hospital stay of around 8 to 10 days, and a gradual return to normal eating and activity. Our compassionate care teams closely monitor patients for infections or any other complications. Some patients may spend time in the intensive care unit (ICU) immediately after surgery for closer observation.
During your hospital stay, your recovery from pancreatic surgery will focus on:
- Transitioning back to solid foods. Patients usually begin with clear liquids and slowly transition to solid foods as the digestive system recovers.
- Regaining active movement. Most people are encouraged to get out of bed and walk soon after surgery to support recovery.
- Pain management. Initially, you’ll be able to control your pain medication through an epidural catheter or IV line. Once you are able to eat, you’ll receive oral pain medication.
Upon being discharged from the hospital, most patients can go home, while some may stay nearby for follow-up care or transition to a rehabilitation facility for additional support. Patients traditionally return to their usual activities within 4–6 weeks, depending on their health and the complexity of the surgery.
After returning home, recovery focuses on symptom management, healing, and gradually resuming daily activities:
- Managing pain. Mild pain, soreness, or tightness is expected and improves over time. Take medications as directed and avoid driving or alcohol while using prescription pain medicine.
- Eating and digestion. Appetite may be low, and you may feel full quickly. Small, frequent meals can help maintain nutrition. Some weight loss is common.
- Bowel habits. Constipation or diarrhea can occur during recovery. Stay hydrated and contact your care team if symptoms persist.
- Incision care. Numbness or tightness around the incision is normal. Keep the area clean and dry, and report any redness, swelling, or drainage.
- Activity and energy. Light activity, such as walking, is encouraged, but avoid heavy lifting. Fatigue is common and improves gradually over several weeks.
- Follow-up care. You’ll have follow-up visits to monitor healing and guide the next steps in your recovery. Test results will determine if all the cancer was removed and if any cancer cells were in the lymph nodes.
Possible complications from the Whipple procedure can include:
- Delayed gastric emptying, where the stomach may take longer to empty after surgery. This often improves within 7–10 days, but some patients may temporarily require nutritional support through a feeding tube or intravenous methods.
- Pancreatic leak (pancreatic fistula): A less common but more serious complication, occurring in about 10% of patients, caused by leakage at the surgical connection between the pancreas and small intestine. It is typically managed with drainage and antibiotics, though some patients may need additional nutritional support.
Recovery after a Whipple procedure is gradual and potentially challenging, taking 2 to 6 months or longer for fatigue and digestive difficulties to subside. But with careful monitoring and support, most patients can regain strength and return to their usual routines over time.
Questions to ask your surgeon
Questions to ask your surgeonWhen considering pancreatic surgery, it’s important to ask your surgeon key questions to help you prepare and make informed decisions about your care:
- Can my tumor be removed through surgery?
- How many pancreatic surgeries have you personally performed, and how many a year?
- How many Whipple procedures are performed at your hospital every year?
- What are the possible risks and complications of the Whipple procedure?
- What is the typical hospital stay and recovery timeline after surgery?
- What changes or challenges can I expect in my daily life after the procedure?
- Is there a team of physicians involved in my care?
Choose NewYork-Presbyterian for pancreatic surgery
Choose NYP for pancreatic surgeryOur pancreatic surgeons are some of the most experienced in the world, with the first robotic Whipple procedure at the Pancreas Center at NewYork-Presbyterian/Columbia University Medical Center. Whether you need evaluation, advanced pancreatic cancer treatment, the Whipple procedure, or a second opinion, our multidisciplinary team is here to guide you every step of the way.
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CENTER FOR ADVANCED DIGESTIVE CARE
NewYork-Presbyterian
LIVER TRANSPLANTATION, HEPATOBILIARY AND PANCREATIC SURGERY
Weill Cornell Medicine