Whipple’s procedure was first described by Allan Whipple in the 1930’s. It is remembered as being a procedure of high mortality, in the 1970’s. Almost 25 % of the patients who underwent the surgery died due to the surgery. However over the years, it has become an extremely safe operation. This procedure is currently done by select surgeons at some centers with a mortality rate of the operation being less than 4 %.
Description of the procedure: In this operation the head of the pancreas, a portion of the bile duct, the gall bladder and the duodenum is removed. In some cases a portion of the stomach may be removed. Finally the gastrointestinal secretions must be directed back into the gut; hence the remaining pancreas, bile duct and the intestine are sutured back into the intestine. Currently a laparoscopic procedure for Whipple’s operation is being developed and can be used for patients suffering from cystic tumours, islet cell tumours and chronic pancreatitis.
Indications for Whipple’s procedure: This operation is performed for the following cases: Cancer of the head of the pancreas, cancer of the duodenum, cancer of the ampulla (ampulla is an area where the bile and pancreatic duct enter into the duodenum), cholangiocarcinoma, in some benign conditions like chronic pancreatitis and benign tumours of the head of the pancreas.
Complications following surgery:
Risk of developing diabetes: since a part of the pancreas is removed during the surgery the exocrine part of the pancreas is lost, which is chiefly responsible for production of insulin. Those patients who had diabetes prior to the procedure or who had borderline diabetes and were on a diet in order to maintain blood sugar levels, may suffer post operation and have a high chance of worsening of their blood sugar levels. Those who did not have diabetes before surgery and do not have any history of diabetes or chronic pancreatitis have a low risk of developing diabetes post surgery.
The operation is curative in benign or low grade cancers of the pancreas. In cases of pancreatic adenocarcinoma the overall survival after Whipple procedure is about 20 % at five years after surgery and those who have had metastasis to the lymph nodes have a 40 %survival rate. Post surgery patient may require chemotherapy and radiation therapy, which increase the survival rate by a further 10% in post surgery patients of pancreatic adenocarcinoma.
Pancreatic fistula: After the tumour has been removed the rest of the pancreas is sutured back into the intestine to allow the drainage of pancreatic juices into the gut. Some patients develop leakage of pancreatic juices and hence a drainage catheter is left in situ. The leakage however heals on its own. Only few cases may develop a fistula and require re- operation in order to treat the complication.
Gastroparesis: This means paralysis of the stomach post surgery. The patient may be put on intravenous fluids until the bowel sounds return and the bowels start functioning normally. It is a common finding post five to six days of surgery.
Malabsorption is another complication following Whipple’s Procedure. Decreased production of pancreatic enzymes post surgery is common and hence there may be hampered digestion of fats in the intestines which in turn could cause steatorrhoea. Long term oral supplements of pancreatic enzymes may be given to the patient.
Weight loss too may be a complication following surgery.
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