What Are the Different Procedures That Constitute a Whipple Procedure?

The Whipple procedure, or pancreaticoduodenectomy, is a procedure to remove part of the pancreas as a treatment for pancreatic cancer.

The pancreas is a gland situated in the abdomen (behind the stomach). The head of the pancreas is on the right side of the abdomen and is connected to the duodenum (the first section of the small intestine) through a small tube called the pancreatic duct. The narrow end of the pancreas, called the tail, extends to the left side of the body. The pancreas is a vital organ that works closely with the liver and ducts that carry bile. The pancreas releases (secretes) enzymes that help digest food, especially fats and protein. The pancreas also secretes hormones that help manage your blood sugar. Pancreatic cancer is the fourth leading cause of cancer death for both men and women.

The Whipple procedure is a standard procedure to remove pancreatic cancer or a tumor. The procedure is named after Allen Oldfather Whipple (former chairman of the Department of Surgery at Columbia University) who pioneered the procedure. 

In the Whipple procedure, a surgeon removes the head of the pancreas, the gallbladder and the first section of the small intestine (the duodenum). Occasionally, a small part of the stomach is also removed. The Whipple procedure is also called pancreaticoduodenectomy.

There are two common types of Whipple procedures: the conventional Whipple and the pylorus-preserving pancreaticoduodenectomy.

• The conventional Whipple: This involves the removal of the head of the pancreas, the duodenum and a portion of the stomach, as well as the gallbladder and a portion of the bile duct. The remaining stomach, bile duct and pancreas are then reconnected to the digestive tract to restore the flow of ingested contents, digestive enzymes and bile. 
• The pylorus-preserving pancreaticoduodenectomy: In this, the terminal section of the stomach is not removed during the operation. The diseased part is removed, and the remaining is reconnected to the digestive tract.

The Whipple procedure may be done in various ways:

• Open surgery: During an open procedure, the surgeon makes an incision in the stomach to access the pancreas. This is the most common approach and the most studied.
• Laparoscopic surgery: During this surgery, the surgeon makes several small cuts in the abdomen and inserts special instruments, including a camera that transmits video to a monitor in the operating room. The monitor guides the surgeon to navigate while performing the Whipple procedure. Laparoscopic surgery is a type of minimally invasive surgery.
• Robotic surgery: This is a type of minimally invasive surgery in which the surgical tools are attached to a mechanical device (robot). The surgeon sits at a console nearby and uses hand controls to direct the robot. A surgical robot can use tools in tight spaces and around corners, where human hands may be too large to be effective.

Minimally invasive surgery offers some benefits, such as lower blood loss and a quicker recovery in those without complications. However, it also takes longer. Sometimes, a procedure may begin with minimally invasive surgery, but complications or technical difficulty requires the surgeon to make an open incision to finish the operation.

The Whipple procedure is a difficult operation, often involving an open surgery. It carries risks both during and after the surgery. These may include

• bleeding at the surgical areas,
• infection of the incision area or inside your abdomen,
• delayed emptying of the stomach, which may make it difficult to eat or to keep food down temporarily,
• leakage from the pancreas or bile duct connection and
• diabetes, temporary or permanent.

The chances of long-term survival after the Whipple procedure depend on the patient’s particular situation. For most tumors and cancers of the pancreas, the Whipple procedure is the only known cure. Hence, the Whipple procedure increases the survival chances in patients with pancreatic cancer.