Surgery – The “Whipple” Operation

The “Whipple” Operation

In its early stages, pancreatic cancer can be treated by a “Whipple” operation. This operation was first described by an Italian, Allesandro Codivilla in 1898, popularised in Europe by Dr Walther Kausch from Germany in 1909, but has become associated with Dr Alan Whipple from New York in the 1930s. It is also known as a “pancreatoduodenectomy”. This is a major operation that should only be carried out by a specialist surgeon, so you may have to travel to a specialist unit to have it carried out.

What happens during a Whipple operation?

The operation normally lasts for between four and seven hours. The surgeon aims to completely remove the cancer, in order to give you the best chance of a cure. The head of the pancreas, a portion of the bile duct, the gallbladder and the duodenum are also removed, along with part of the stomach. After their removal, the remaining pancreas, bile duct and stomach are joined up to the intestine. This allows the pancreatic juice, bile and food to flow into the gut, so that digestion can proceed normally.

The surrounding lymph nodes may also be removed to reduce the risk of the cancer spreading or coming back. The chance of the cancer recurring depends on the type of tumour you have. This will only be confirmed after your operation, when the pathologist examines the removed pancreas.

Recovering from an operation for cancer of the pancreas

Changes in your diet

The pancreas produces enzymes to aid digestion and absorption of food and nutrients. Because of this, any kind of surgery that removes part or all of the pancreas will affect your ability to digest and absorb food and nutrients.

It is important after any surgery to try and have as nutritious a diet as possible, in a form that you are able to take, and which provides the best amounts of nutrients.

Try to take enough calories and protein in a form that you can cope with, either as liquids, soft diet or normal foods.

Try to have a good variety of protein foods such as meat, chicken, fish, eggs, milk and cheese, as well as foods that provide energy such as bread, pasta, rice, potatoes and cereals.

Small frequent meals with snacks such as crackers and cheese, full fat yogurts, cakes and biscuits, are often easier to take.

Foods such as fruit and vegetables provide vitamins and minerals, and should be included daily.

The dietitian may provide advice or supplementary information on managing your diet.

Things that can happen after surgery (but which probably won’t!!)

Anastomotic leak

By far the most significant complication following a pancreatico-duodenectomy is where one of the anastomosis (the joins between the bowel and the liver and pancreas) do not heal properly, allowing the contents of the intestine to leak outside the bowel. When surgical drains have been left near to the joins, the leaking fluid may be controlled, and no other intervention required. However, if the leak is making you unwell, this may require further surgery or the insertion of a drain under X-ray control to regain control.

Delayed emptying of the stomach

Sometimes your stomach may take longer to adapt to the changes after surgery and your food may not be able to pass through efficiently. You may need to stick to a liquid diet only for a while. Alternatively, you may need to take your nourishment through a naso-gastric tube until the problem goes away.

Chyle leak

Some patients may release a milky type of fluid (chyle) into their abdominal drain after surgery. Chyle is lymphatic fluid that builds up in the abdomen following trauma due to surgery. This resolves by reducing or stopping your oral intake for a period of time. Your dietitian or surgeon may feel that you should have artificial feeding during this period to support your nutritional intake.

Problems with absorption

When you have had part of your pancreas removed, you may notice your stools (motions) have become pale, loose and greasy. You can correct this by taking a pancreatic enzyme capsule, called Creon or Pancrex, which will help you to digest your food.

Feelings after a major operation

Some people may overwhelmed after surgery and this can lead to feelings of confusion and frequent changes of mood. These emotions are part of the process that many people go through in trying to come to terms with their illness. There may be times when you want to be left alone to sort out your thoughts and feelings. Other members of your family may experience similar emotions.

We would encourage you, though, to stay in close, routine contact with friends and family if you can, so that you can share your problems with those who care about you. We would also encourage you to continue with your daily life as much as practicable, so that you can ease your way back into normal life as quickly and easily as possible.

Your pancreatic team will always be ready to offer support and help both to you and your family, no matter what your feelings or circumstances.