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Pancreaticoduodenectomy (Whipple procedure)
A Pancreaticoduodenectomy is the removal of the head of the pancreas, part of the duodenum, the lower bile duct, and the gallbladder. It is often called a Whipple procedure.
The head of the pancreas, part of the duodenum (small intestine), the lower bile duct, and the gallbladder are removed. The remaining bile duct and pancreas are reconnected to the small intestine.
Preparing before surgery
Keep up with your regular activities, exercise and eat a balanced diet. You want to be as strong as you can before you have the surgery.
Arrange for someone to help you around the house and do errands for you when you come home after surgery.
Bowel prep You may need to prepare your bowels for surgery.The surgery takes about 5 to 6 hours. You can expect to stay in the hospital for 7 to 10 days.
Day of your surgery
On the morning of your surgery go to the Same Day Surgery Unit. A nurse will admit you and start your intravenous, or IV. You may be given some medications. You will then go to the Operating Room, either walking or on a stretcher. Your family may go with you and wait in the waiting area outside of the Operating Room.
Operating Room, or OR You will see nurses and doctors in the OR. The anesthesiologist will give you some medication to help you fall asleep.
After your surgery,
You may go to the Intensive Care Unit, or ICU depending on your doctors orders.
Intensive Care Unit, or ICU In the ICU you are watched very closely. A nurse will be with you as you wake up. You are in the ICU overnight.
Along with your IV, you may have different tubes and drains. These include: • An epidural catheter is when the pain medicine is given through a thin tube into a small space in your lower back. • A tube called a catheter in your bladder to drain urine during surgery. • Tubes or drains near your incision area to drain extra fluid that can build up after surgery. • A Nasogastric or NG tube. This is a tube that goes down your nose into your stomach to drain fluid.
You may have to wear special boots called moon boots on your legs. These boots help prevent blood clots.
On the ward On the ward the nurse will check your blood pressure, heart rate and temperature (vital signs) and dressing as needed. Your family can visit you on the ward.
Dressing and incision
Your incision is under your rib cage, across your stomach area. The incision will be covered by a dressing. The dressing will be removed 2 to 3 days after surgery.
The incision will be closed with staples, which will be taken out in about one week after your surgery. If the staples are still in when you leave the hospital, they may be taken out by your family doctor, home care nurse or at your follow-up appointment with your surgeon.
You will have pain and discomfort after surgery, especially around your incision. Pain medicine will be given to you on a regular basis to keep you comfortable and your pain under control.
Pain medicine can be given in different ways: • in your intravenous, or IV • epidural - usually given for 3 to 5 days • pain pump - a pain pump is when you give yourself the pain medication through your IV • pills - when you are able to drink fluids
Most pain medicines can make you constipated. Stool softeners will be given to help prevent this problem. You may also feel nauseated or sick to your stomach. Medicine will be given to decrease this feeling.
You may also have stomach discomfort related to gas pains for a few days after surgery. Walking helps to lessen this discomfort.
You will be encouraged to do deep breathing, coughing and leg exercises after surgery.
The first day after surgery you will be helped to walk a short distance. You will be encouraged to increase your activities every day. A physiotherapist may help you with some of these activities.
Walking and increasing your activities helps to keep your lungs healthy and prevent blood clots.
Feeling tired It is normal to feel tired after surgery. It may take a while for your energy to return to normal. Everyday do a bit more, walk a little farther.
You will have an IV for fluids and medicine. Your IV is removed when you are drinking and if not needed for medicine.
For the first few days you will not have anything to eat or drink. Slowly, you will start drinking clear fluids. You will slowly eat solid foods. You may find that you need to eat small amounts of food 4 to 6 times a day.
The pancreas helps our bodies digest fats and control sugar.
You may have a hard time digesting fats and have diarrhea. You will most likely lose weight after surgery. There is a small chance that you may develop diabetes after your surgery. Diabetes is when your body does not use sugar properly.
A dietitian is available to talk with you about eating a healthy diet as you recover from surgery.
The Whipple procedure. You may be placed on enzyme replacement medication to be taken with meals and snacks.
A nurse will review with you what you need to know about how to care for yourself at home. When you go home, you may not feel as strong as you did before surgery. Please discuss your wishes and concerns, with the health care team, so they know your needs when planning your discharge.
Avoid heavy lifting (5 lbs or 2 kgs) or straining for at least 6 to 8 weeks.
If you are taking pain medicine with a narcotic, such as codeine do not drive, operate heavy machinery or drink alcohol.
When you go home, you will be given:
prescriptions for pain medicine, stomach medicine, and a stool softener a follow-up appointment with your surgeon
Call your surgeon if you have:
• a temperature greater than 38.5oC or 101oF • redness, swelling, odour, discharge or increased pain at or around the incision area • other concerns about your incision • pain or a hard timing passing urine • vomiting, or diarrhea • constipation or no bowel movement for 3 days • jaundice-you notice that the whites of your eyes are yellow or that your skin looks yellow • other concerns that you feel may be related to surgery. Call your surgeon or doctor immediately with any and all concerns as something small may signify a bigger problem. Do not start or try anything new with your care without permission from your doctor.
The above information was obtained from:
©Hamilton Health Sciences, 2007 PD 5446 – 06/2007 dt/June 11, 2007 WPC\PtEd\WhippleProcedure-th.doc