A Patient’s Guide to Whipple Surgery

Facing a pancreatic cancer diagnosis can be overwhelming. For many patients, the Whipple procedure becomes a key surgical option when the tumour is located in the head of the pancreas. This complex surgical operation is primarily used to treat cancers located in the pancreas, bile duct, and duodenum, particularly when the tumour is confined to the head of the pancreas. However, not every patient is suitable for this surgery, and eligibility depends on the tumour’s location, stage, and overall health status.

The Whipple procedure (pancreaticoduodenectomy) is a complex surgery primarily used to treat cancers located in the head of the pancreas. It may also be performed for other conditions affecting the pancreas, duodenum, bile duct, or gallbladder.

In a standard Whipple, part of the stomach is removed. In a pylorus-preserving version, the stomach and pylorus are left intact, which may support better digestion. The surgery typically takes 5–8 hours and can be performed using open, laparoscopic, or robotic approaches.

After removing the affected organs, the remaining pancreas, bile duct, and stomach are reconnected to the small intestine to maintain digestive function.

Whipple surgery is considered when the disease is confined to the pancreatic head region and can be removed completely. This includes:

• Pancreatic Cancer (confined to the head or neck)
• Bile Duct Cancer (in the part near the pancreas)
• Duodenal Cancer (in the first part of the small intestine)
• Ampullary Cancer (where the bile and pancreatic ducts meet)
• Chronic Pancreatitis (select cases with intractable symptoms and failed conservative treatment)
• Pancreatic Cysts (high-risk or symptomatic lesions)

These indications align to remove all diseased tissue while preserving as much normal digestive function as possible.

Candidacy for a Whipple procedure is determined based on factors, such as:

• Location of the Tumour: The tumour must be in the head of the pancreas, the bile duct, the duodenum, or the ampulla of Vater.
• No Metastasis: The disease should not have spread (metastasised) to distant organs such as the liver, lungs, or abdominal cavity.
• Resectability: The tumour must be technically removable without damaging critical blood vessels or other essential structures.
• Overall Health: The patient must be healthy enough to tolerate a major abdominal operation. Factors such as age, nutritional status, and presence of other medical conditions (like chronic obstructive pulmonary disease, heart disease, or obesity) may increase risk, but do not always exclude someone from surgery.
• Benign Conditions: In some cases, patients with chronic pancreatitis, pancreatic cysts, or trauma to the pancreas or duodenum may also be considered for Whipple surgery if conservative management is ineffective.

Knowing what to expect during and after surgery is an important part of the decision-making process for any patient. Here are some considerations on what to expect during and after the surgery:

• Surgical Procedure
  • Duration: 5–8 hours
  • Anaesthesia: Performed under general anaesthesia
  • Technique: Open or minimally invasive approach, depending on patient condition and surgeon’s expertise
• Recovery Time
  • Duration: 5–8 hours
  • Anaesthesia: Performed under general anaesthesia
  • Technique: Open or minimally invasive approach, depending on patient condition and surgeon’s expertise
• Postoperative Care
  • Pain Management: Medications are prescribed for comfort and healing
  • Physical Activity: Early movement and physiotherapy are encouraged to prevent blood clots.
  • Dietary Adjustments: Starts with clear liquids, progressing to soft solids; small, frequent meals are advised
  • Supplements: Some patients may need pancreatic enzyme supplements or vitamins to support digestion
  • Wound care: Keep the surgical site clean and dry. Dressings should be changed as instructed, and any signs of infection such as redness, swelling, or discharge should be reported to the care team.
• Monitoring : Regular follow-up appointments are essential to monitor recovery and address any complications or nutritional issues.

Whipple surgery, while potentially curative, is a major operation with significant risks and complications. Awareness of these risks and the importance of surgical expertise can help patients make informed decisions about their care.

• Infection: At the incision site or internally
• Bleeding: Which may require intervention
• Delayed Gastric Emptying (DGE): Where food takes longer to leave the stomach
• Digestive Issues: Such as diarrhoea, weight loss, or malabsorption
• Anastomotic Leak: Where the surgical connections between organs may leak, requiring further treatment

Not all patients will experience these complications, but it is important to be aware and prepared.

If you or a loved one is facing a diagnosis that may require surgery, it is crucial to consult with specialists who offer personalised, expert care.

At Digestive & Liver Surgery Centre in Singapore, our surgeons utilise modern techniques such as laparoscopic and robotic surgeries to ensure optimal outcomes. Contact us today to learn more or to schedule a consultation for your Whipple procedure in Singapore.