A Whipple procedure — also known as a pancreaticoduodenectomy — is a complex operation to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct.The Whipple procedure is used to treat tumors and other disorders of the pancreas, intestine and bile duct. It is the most often used surgery to treat pancreatic cancer that's confined to the head of the pancreas. After performing the Whipple procedure, your surgeon reconnects the remaining organs to allow you to digest food normally after surgery.

The Whipple procedure is a difficult and demanding operation and can have serious risks. However, this surgery is often lifesaving, particularly for people with cancer.Depending on your situation, your doctor may talk with you about other pancreatic operations. Seek a second opinion from a specialized surgeon if needed. Options include:

Surgery for tumors or disorders in the body and tail of the pancreas. Surgery to remove the left side (body and tail) of the pancreas is called a distal pancreatectomy. With this procedure, your surgeon may also need to remove your spleen.

Surgery to remove the entire pancreas. This is called total pancreatectomy. You can live relatively normally without a pancreas but will need lifelong insulin and enzyme replacement.

Surgery for tumors affecting nearby blood vessels. Many people are not considered eligible for the Whipple procedure or other pancreatic surgeries if their tumors involve nearby blood vessels. At a very few medical centers in the United States, highly specialized and experienced surgeons will safely perform these operations in select patients. The procedures involve also removing and reconstructing parts of blood vessels.

A Whipple procedure may be a treatment option for people whose pancreas, duodenum or bile duct is affected by cancer or other disorder. The pancreas is a vital organ that lies in the upper abdomen, behind your stomach. It works closely with the liver and ducts that carry bile. The pancreas releases (secretes) enzymes that help you digest food, especially fats and protein. The pancreas also secretes hormones that help manage your blood sugar.

The Whipple procedure is a technically difficult operation, often involving open surgery. It carries risks both during and after surgery. These may include:Delayed emptying of the stomach, which may make it difficult to eat or to keep food down temporarilyExtensive research shows that surgeries result in fewer complications when done by highly experienced surgeons at centers that do many of these operations. Don't hesitate to ask about your surgeon's and hospital's experience with Whipple procedures and other pancreatic operations. If you have any doubts, get a second opinion.

The morning of surgery, you'll check into the admission desk and register. Nurses and staff members will confirm your name, date of birth, procedure and surgeon. You will then need to change into a surgical gown in preparation for surgery.

Before your surgery, an intravenous (IV) line is put into a vein, usually in your arm. This is used to inject fluid and medication into your veins as needed. You may also receive some medication to help you relax if you are nervous.

You may also undergo placement of an epidural catheter or a spinal injection in addition to local nerve blocks to the abdominal wall. These procedures allow you to recover with minimal pain and discomfort after surgery and help to decrease the amount of narcotic pain medication you will need.

A surgical team works together to enable you to have a safe and effective surgery. The team is made up of pancreatic surgeons, specialized surgical nurses, anesthesiologists and anesthetists — doctors and nurses trained in giving medication that causes you to sleep during surgery — and others.After you are asleep, additional intravenous lines may be placed with other monitoring devices, depending on the complexity of the operation and your overall health conditions. Another tube, called a urinary catheter, will be inserted into your bladder. This drains urine during and after surgery. It is typically removed one or two days after surgery.

Surgery may take four to 12 hours, depending on which approach is used and the complexity of the operation. Whipple surgery is done using general anesthesia, so you'll be asleep and unaware during the operation.

The surgeon makes an incision in your abdomen to access your internal organs. The location and size of your incision varies according to your surgeon's approach and your particular situation. For a Whipple procedure, the head of the pancreas, the beginning of the small intestine (duodenum), the gallbladder and the bile duct are removed.

Richard Potvin

Genearl surgery:open access