Pancreaticoduodenectomy (Whipple procedure)

Pancreaticoduodenal resection (Whipple procedure) is a surgical intervention that involves the removal of the head of the pancreas together with the duodenum, gallbladder, and part of the bile duct. If necessary, part of the stomach is also removed. The Whipple procedure is most often performed for malignant tumors of the head of the pancreas, as well as for certain neoplasms of the duodenum and bile ducts.

The distinctive feature of this intervention is that after the removal of the affected organs and tissues, the surgeon must restore the functioning of the digestive system. For this purpose, new connections are formed between the remaining part of the pancreas, the bile ducts, the stomach, and the small intestine.

At the Oxford Medical clinic in Kyiv, such operations are performed by a team of surgeons led by a Doctor of Medical Sciences with over 30 years of experience. The operating rooms are equipped with modern equipment for complex interventions on the abdominal organs. After surgical treatment, patients are provided with round-the-clock monitoring, necessary medication support, and inpatient care.

For a consultation regarding the possibility of undergoing surgery at Oxford Medical, call the contact center or fill out the appointment form on the website.

Among operations for cancer of the head of the pancreas, pancreaticoduodenal resection is the main method of radical surgical treatment if the tumor can be completely removed. Such an intervention is used much less frequently when stomach cancer spreads to the duodenum and pancreas. The decision regarding surgery in such cases is made individually, taking into account the extent of the disease and the patient's general condition.

Pancreaticoduodenal resection is performed only when the expected benefit of the intervention outweighs the possible risks. Before the operation, doctors assess not only the extent of the disease but also the body's ability to withstand complex surgical treatment.

The main contraindications are:

• distant metastases of a malignant tumor;

• significant involvement of major blood vessels that makes complete removal of the neoplasm impossible;

• severe decompensated diseases of the heart, lungs, or other vital organs;

• severe exhaustion and serious disturbances of the general condition that cannot be corrected before the intervention.

Some restrictions may be temporary. For example, in cases of inadequate nutrition, anemia, or concomitant diseases, the necessary treatment and preparation are carried out first. After the patient's condition stabilizes, the possibility of surgery is reassessed.

Doctors at Oxford Medical explain: if the tumor cannot be removed, the patient may be prescribed chemotherapy. To relieve symptoms, if indicated, bile duct stenting is performed to restore bile outflow and reduce jaundice, or a stent is placed in the duodenum if the tumor obstructs the passage of food.

Before the operation, a consultation with an oncological surgeon and a comprehensive examination are necessary. The doctor assesses the size and extent of the tumor, its relationship with major blood vessels, as well as the patient's general health condition. This helps determine the possibility of surgical removal of the neoplasm and assess the risks of the intervention.

Preparation includes:

• Laboratory tests. General and biochemical blood tests, a coagulogram, determination of blood group and Rh factor, and other tests if indicated.

• Instrumental diagnostics. CT with contrast enhancement according to a special protocol for the pancreas, if necessary — MRI of the abdominal organs.

• Assessment of the function of the heart and other organs. ECG, consultation with an anesthesiologist, and additional examinations in the presence of concomitant diseases.

• Correction of health disorders. Treatment of anemia, control of blood glucose levels, correction of nutrient deficiencies and other conditions that increase the risk of complications.

If the tumor blocks the bile duct and causes jaundice, endoscopic stenting is performed before the operation if certain indications are present. During the procedure, a small tube — a stent — is placed in the duct to ensure bile outflow. Such an intervention is not necessary for all patients.

Several weeks before the operation, it is advisable to stop smoking and drinking alcohol, maintain adequate nutrition and daily physical activity according to well-being. If the patient takes medications for blood thinning or treatment of diabetes mellitus, the doctor determines in advance whether their administration needs to be changed. Medications must not be discontinued independently.

On the day before the operation, it is necessary to follow a light diet and avoid fatty and hard-to-digest dishes. Solid food consumption should be stopped at least 6-8 hours before anesthesia, and clear liquids — 2 hours before anesthesia, if there are no other medical restrictions. On the day of the intervention, medications must not be taken independently without prior agreement with the doctor.

PDR surgery is performed under general anesthesia. It usually lasts 4–8 hours, but in cases of complex tumor location or the need for blood vessel reconstruction, it may take longer. The intervention is most often performed through an incision in the anterior abdominal wall, although in some cases minimally invasive technologies may be used.

The main stages of the operation:

• Examination of the abdominal organs. The surgeon checks the extent of the tumor, the condition of the surrounding tissues and blood vessels. If changes are detected that do not allow the neoplasm to be safely removed, the intervention plan may be reconsidered.

• Removal of affected tissues. The doctor removes the head of the pancreas, the duodenum, the gallbladder, and part of the bile duct. If indicated, part of the stomach is also removed. In cases of malignant tumors, regional lymph nodes are removed.

• Restoration of the digestive tract. The remaining part of the pancreas and the bile duct are connected to the small intestine. A separate connection between the stomach and the intestine is formed so that food can pass further through the digestive tract.

• Completion of the operation. The surgeon checks for the absence of bleeding and the integrity of the formed connections, places drains if necessary, and sutures the surgical wound.

After the intervention, the patient is transferred to the postoperative ward or intensive care unit, where breathing, blood pressure, glucose levels, and other important indicators are monitored. When the condition stabilizes, the patient continues treatment in the surgical inpatient department.

After PDR surgery, the patient remains in the surgical inpatient department, where they receive the necessary treatment and care. In the first days, it is important to prevent postoperative complications, provide effective pain relief, and gradually restore physical activity. Medical staff help the patient move around, monitor wound healing, and perform dressing changes in a timely manner.

Recovery takes place gradually:

• The first 1–2 days. If the patient feels satisfactory, they are helped to sit up, get out of bed, and take their first steps. This is necessary to prevent thrombosis and congestion in the lungs.

• The next 3–5 days. The patient begins to walk more and gradually transitions to moving independently. The doctor assesses wound healing and removes drains if necessary.

• Before discharge. The patient must be able to move independently, eat, and perform basic daily activities. Hospitalization usually lasts 7–14 days, but it may be longer after complex interventions.

After discharge, daily walks, sufficient rest, and a gradual return to household activities are recommended. For 6–8 weeks, it is necessary to avoid lifting heavy objects, intensive training, and physical work that requires significant effort.

Doctors at Oxford Medical note: during the recovery period, weakness, rapid fatigue, decreased appetite, and loss of body weight may be observed. If difficulties with digesting food arise, the doctor may prescribe enzyme preparations. It is also important to attend follow-up examinations to detect disorders in a timely manner and adjust treatment if necessary.

After pancreaticoduodenal resection, the digestive process changes because food passes through the stomach and intestines by a different route, and the amount of digestive enzymes may decrease. Therefore, in the first weeks, it is important to eat small portions, gradually expand the diet, and monitor how the body reacts to different foods.

Main dietary recommendations:

• eat 5–6 times a day in small portions, chewing food thoroughly;

• include protein-rich foods in every main meal — meat, fish, eggs, or fermented dairy products;

• give preference to boiled, stewed, and baked dishes, especially in the first weeks;

• temporarily limit fried, excessively fatty foods and products that cause bloating or diarrhea;

• introduce fresh vegetables, fruits, and foods high in fiber gradually, taking into account how you feel;

• drink sufficient fluids throughout the day, if necessary — mainly between meals.

After the operation, a deficiency of digestive enzymes may occur, causing fats and other nutrients to be absorbed less effectively. Frequent bowel movements, fatty stools, abdominal bloating, and weight loss may indicate this. In such cases, the doctor prescribes enzyme preparations that are taken with food. It is important not to completely exclude fats from the diet, as they are necessary for maintaining weight and absorbing fat-soluble vitamins.

Doctors at Oxford Medical recommend regularly monitoring body weight after discharge. In the event of rapid weight loss, worsening appetite, or persistent digestive disorders, it is necessary to consult a doctor. Such symptoms may indicate insufficient intake of nutrients or impaired absorption, so adjustments to nutrition and enzyme therapy may be required.

Pancreaticoduodenal resection is considered a complex surgical intervention because it involves the removal of several anatomical structures and the restoration of pathways for the passage of food and digestive juices. Even when the operation is performed correctly, there is a risk of complications that may require additional treatment or a longer hospital stay.

Possible complications include:

• pancreatic fistula — leakage of pancreatic juice due to a loss of integrity of the connection between the remaining part of the pancreas and the intestine;

• bleeding, which may occur in the first hours after the intervention or later;

• delayed gastric emptying, accompanied by nausea, vomiting, and a feeling of fullness;

• infection of the postoperative wound or the formation of an abscess in the abdominal cavity;

• thrombosis and thromboembolism — the formation of blood clots in blood vessels with possible impairment of blood circulation.

In addition to early complications, some patients subsequently develop a deficiency of digestive enzymes or impaired insulin production. This can lead to digestive disorders, loss of body weight, and increased blood glucose levels. Such conditions require monitoring and appropriate treatment.

Doctors at Oxford Medical warn: after discharge, it is necessary to seek medical assistance urgently if severe or increasing abdominal pain, elevated body temperature, repeated vomiting, or an inability to consume food and fluids occurs. Redness, swelling, or purulent discharge from the wound also requires an urgent examination. In the event of sudden shortness of breath, chest pain, or loss of consciousness, emergency medical assistance should be called.

The cost of pancreaticoduodenal resection is calculated individually. The price is influenced by:

• the location of the tumor and the degree of involvement of adjacent tissues;

• the need for reconstruction of major blood vessels;

• the specific features of anesthesia and the duration of the intervention;

• the required extent of treatment and the length of hospital stay.

You can familiarize yourself with the current prices for medical services here. The final cost is determined after examinations and the preparation of a surgical treatment plan. To schedule a consultation with a surgeon in Kyiv, call the Oxford Medical contact center or fill out the online appointment form on the website.

The information is for informational purposes only and does not replace a doctor's consultation.

Sources:

• National Cancer Institute (NCI)

• US National Library of Medicine (PubMed)

• National Institutes of Health (NIH)