Definition :
The classic Whipple procedure is named after Allen Whipple, MD, a Columbia University surgeon who was the first American to perform the operation in 1935.
The goal of the Whipple procedure (pancreatoduodenectomy) is to remove the head of the pancreas, where most tumors occur. Because the pancreas is so integrated with other organs, the surgeon must also remove the first part of small intestine (duodenum), the gallbladder, the end of the common bile duct and sometimes a portion of the stomach. In the reconstruction phase of the operation, the intestine, bile duct and remaining portion of the pancreas are reconnected.
The Whipple procedure is the most common operation to remove pancreatic cancers. The Whipple procedure may also be used to treat some benign pancreatic lesions and cysts and cancers in the bile duct and beginning part of the small intestine (duodenum).
Pancreas :
Pancreas is a spongy, leaf-shaped gland that is about 6 inches long and 2 inches wide. It lies in the back of the abdomen, behind the stomach and above the small intestine. The major function of the pancreas is to secrete hormones and enzymes. These hormones are insulin and glucagon, which help to keep the blood sugar levels normal. Enzymes help break down food. Pancreatic enzymes help the body digest fat.
Indications for a Whipple Procedure
A Whipple operation is performed for
- cancer of the head of the pancreaas
- cancer of the duodenum.
- cholangiocarcinoma (cancer of the the bottom end of the bile).
- cancer of the ampulla – an area where the bile and pancreatic duct enter into the duodenum.
- whipple operation may also sometimes be performed for patients with benign (non-cancerous) disorders such as chronic pancreatitis and benign tumors of the head of the pancreas.
Only about 20% of pancreatic cancer patients are eligible for the Whipple procedure and other surgeries. These are usually patients whose tumors are confined to the head of the pancreas and haven't spread into any nearby major blood vessels, the liver, lungs, or abdominal cavity. Intensive testing is usually necessary to identify possible candidates for the Whipple procedure. The surgery takes on average six hours to complete. Most patients stay in the hospital for one to two weeks following the Whipple procedure.
Types of Pancreatic Cancer
There are two types of pancreatic cancer, that of the exocrine gland and that of the endocrine gland. About 95 percent of pancreatic cancers begin in the exocrine (enzyme-producing) cells of the pancreas.
Exocrine tumors:Most tumors affecting the exocrine gland are called adenocarcinomas. This type of cancer forms in the pancreas ducts. Treatment for these tumors is based on stage of growth.
Endocrine tumors: These tumors are less common and are most often benign. Though rare, cancer stemming from a pancreatic endocrine tumor (PET) affects the hormone-producing cells. These tumors are also called islet cell tumors or neurendocrine tumors.
Categorization of Wipple Procedures
Standard Whipple Procedure
In a standard Whipple procedure, the surgeon removes the head of the pancreas, the gallbladder, part of the duodenum which is the uppermost portion of the small intestine, a small portion of the stomach called the pylorus, and the lymph nodes near the head of the pancreas. The surgeon then reconnects the remaining pancreas and digestive organs so that pancreatic digestive enzymes, bile, and stomach contents will flow into the small intestine during digestion.
Pylorus preserving Whipple Procedure
In another type of Whipple procedure known as pylorus preserving Whipple, the bottom portion of the stomach, or pylorus, is not removed. Taking out the head of the pancreas is called pylorus preserving pancreaticoduodenectomy (PPPD).
Laparoscopic Whipple Procedure
A laparoscopic Whipple procedure may be offered to select individuals.
The laparoscopic Whipple procedure is performed through six small incisions in the abdominal wall. A laparoscope, a long thin tube with a lighted camera at its tip, is inserted through one incision. The surgeon operates using specially designed surgical instruments placed through the remaining incisions, guided by the laparoscope images shown on a monitor in the operating room.
Laparoscopic Whipple surgery usually takes four to five hours. Most people leave the hospital in four to six days, compared with eight to 10 days for those who have conventional surgery.
Effect of Whipple operation on diabetes
During the Whipple operation part of the pancreas, the head of the pancreas is removed. Pancreatic tissue produces insulin that is required for blood sugar control. When pancreatic tissue is removed the remaining parts of the pancreas may not produce enough insulin and the risk of developing diabetes is present.
Follow up Care required as it is a highly specialized procedure
The Whipple procedure is a difficult and demanding operation for both the person undergoing surgery and the surgeon. The surgery usually lasts between 5-8 hours. The patient needs to stay in the hospital for at least seven days.
The patient might have a decreased appetite after the operation. The body will not be able to digest fats as effectively, so one needs to take medication every time he eats. Another common problem patients experience after surgery is fatigue, which usually lasts for few weeks.
Whipple surgery is a complex surgery that requires great expertise on the part of the surgeon and hence is categorized as a highly specialized procedure.
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