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The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on April 29, 2021.

Whipple procedure

Formally called the pancreaticoduodenectomy, the Whipple procedure is named for the surgeon, Allen Oldfather Whipple, who refined the procedure in the mid-1930s. The Whipple procedure may be recommended if cancer is located in the head or neck of the pancreas (where most tumors occur) and hasn’t spread to other parts of the body.

In addition to pancreatic cancer, the procedure may be used to remove:

Before the procedure

In preparing for a Whipple procedure, you need to consider certain factors, including:

  • Weight gain—If you have pancreatic cancer, you may find you’re losing a lot of weight because the cancer makes it difficult to digest food properly.
  • Improved digestion—Ask your care team whether pancreatic enzyme replacement therapy may help you better digest food.
  • Nutrition support—You may consider working with a dietitian.
  • Strength—If you’re able to exercise, stick to your routine as much as possible. Set small targets to help build strength before surgery.

Additionally, you may need to:

  • Stop smoking before surgery.
  • Stop taking certain medications, especially blood thinners and pain meds.
  • Speak with your care team about your history with anesthesia.
  • Complete pre-op tests, which may include blood count, blood sugar, and kidney and liver function, as well as a chest X-ray and electrocardiogram.

What to expect during the procedure

The surgery, which is performed under general anesthesia, may last four to seven hours, or longer.

The Whipple procedure involves two phases.

  • Phase one
    • First, the surgeon removes the head of the pancreas. Surgeons also may remove the body of the pancreas at the same time. Because the pancreas is so closely tied with other organs, the surgeon may need to remove these nearby parts as well:
      • The first part of the small intestine (duodenum)
      • Part of the bile duct
      • Gallbladder (which stores bile, a fluid, that helps digestion)
      • Lymph nodes near the pancreas
      • A portion of the stomach (the lower end)
  • Phase two
    • The second part of the surgery is reconstruction, as the surgeon then has to reattach what’s left of the bile duct and pancreas to the small intestine. Reattachment is necessary so that bile and digestive enzymes may still enter the small intestine.
    • Next, the stomach is reattached to the small intestine so the food you eat is able to pass through the digestive tract.

Whipple procedure method: Open vs. laparoscopic

Typically, the procedure is done through an incision in the stomach, known as an open procedure. The open procedure typically requires you to be hospitalized for a few days.

Another option may be to perform the procedure laparoscopically, also called keyhole surgery, which is a newer approach that is minimally invasive and offers faster recovery.

With the laparoscopic method, your surgeon needs only to make several small cuts in the belly, rather than one large incision. Through these small cuts, the surgeon inserts a tiny camera and uses the images to guide each step. However, the operation is no less difficult.

To determine which method is best for you, discuss both options with your surgeon.

What to expect from recovery

Recovery depends on the type of surgery and your overall health.

Recommendations are likely to include:

  • Eat smaller, more frequent meals and snacks throughout the day.
  • Choose foods high in calories and protein (to aid in weight gain).
  • Limit how much liquid you drink while eating (think small sips).

You also may need to start or continue pancreatic enzymes to help metabolize your food. Pancreatic enzymes help you absorb fat, carbohydrates and protein in the foods you eat.

Moving may help you feel better after your procedure. It also may help increase your appetite. When you’re ready to resume activity, check with your doctor about which ones are best to pursue, and go slow.

You also may want to work with an occupational therapist and physiotherapist as you recover from surgery.

Possible complications from the Whipple procedure

The most common complication is post-op leaking of pancreatic juices from the site of the incision. A drain may need to be inserted through the skin to allow for the juices to drain. It may be needed for several weeks.

Other possible complications include:

  • Leaking from connections where the surgeon has joined organs
  • Infections
  • Bleeding
  • Problems with stomach emptying after eating
  • Difficulty digesting certain foods
  • Weight loss
  • Bowel habit changes

Some people develop diabetes afterward. While it’s a serious concern, it’s a rare one.

On the less-severe side, after the surgery, you may find sores in your mouth. Check for oral thrush, a mouth infection, as well. If you have oral thrush, you may see white spots on the tongue. The sores and thrush may make you lose your appetite, but it’s easy to treat.

As with any surgical procedure, there are risks of pain and infection. It’s important that you ask about how to best control pain post-surgery and follow your team’s instructions to prevent an infection.

Alternatives to the Whipple procedure

Depending on where the pancreatic tumor is located, your care team may recommend different types of surgery besides the Whipple procedure. These include:

  • Distal pancreatectomy and splenectomy—This surgery removes tumors located in the middle and the tail area of the pancreas. The spleen may be removed as well.
  • Total pancreatectomy—This surgery is rarely done, as it removes the entire pancreas. It’s only considered if the cancer can’t be treated with partial removal of the gland. The surgeon removes the gallbladder, spleen, part of the duodenum, and any nearby lymph nodes. A portion of the stomach may be removed as well.

Speak with your doctor about which surgery may be right for you and the stage of pancreatic cancer.