Whipple operation (minimally invasive)

What is a Whipple procedure?

The term "Whipple procedure" refers to a type of surgery that involves the removal of multiple parts of the digestive tract.

Resection, another term for surgical removal, is performed of the head of the pancreas as well as the gallbladder including a portion of the bile ducts, the duodenum and possibly also a piece of the stomach.

When is a Whipple procedure done?

The primary goal of Whipple procedure is to remove a malignant tumor located in the right portion of the pancreas, also called pancreatic head carcinoma. Considering that this tumor grows in a very aggressive and invasive way, removing only the pancreatic tumor is usually not sufficient. Surrounding organs like the duodenum and gallbladder also must be removed to ensure the optimal prognosis and chance of cure.

What methods are available?

Whipple procedures can be done in an open surgical manner or by a minimally invasive approach.

Moreover, based on the location and whether the tumor is malignant or benign, along with factors specific to the patient, such as previous diseases and prior operations, different surgical methods are favored. Complete removal of the pancreas may also be necessary, referred to as “total pancreatectomy”.

Open Whipple procedure

An open surgery is when the surgeon makes an abdominal incision to reach the respective organs, and it is performed in cases where the tumor has invaded neighboring organs of the pancreas. Also in cases where blood vessels have been infiltrated by the tumor, open surgery is favored because the surgeon has a better overview.

Minimally invasive Whipple procedure

Instead of a major abdominal incision, this recent surgical technique makes use of a minimally invasive approach that is advantageous especially in regard to wound healing and potential complications, although the view of the surgical site is more restricted compared to open surgery.

Robotic surgery is considered a unique type of minimally invasive surgery. This method can also be applied to pancreas surgery.

This involves a robot performing surgical steps on the pancreas, while being operated by the surgeon via a control panel. Like it is common in minimally invasive surgery, the robotic arms is introduced through 4-6 skin incisions, each measuring about 1 cm. The robotic arms can be controlled with great precision to perform the surgeon's hand movements with a high degree of accuracy. The Ultra-HD 3D cameras included offer orientation and an overview of the surgical field.

What is the procedure of pancreatic surgery?

Once the abdominal cavity has been opened, resection of the respective organs can proceed. Following the removal of the pancreatic head, duodenum, gallbladder, parts of the bile duct and possibly a part of the stomach, reconstruction is the next step. As stomach and small intestine are no longer connected due to the missing duodenum, the two organs have to be sutured together. Hence, the surgeon carries out a so-called gastroenterostomy.

Normally, the bile duct carries the bile produced in the liver to the duodenum, where it joins the digestive content. After also this part of the intestine has been removed, bile can no longer reach it, so that the bile ducts need to be reconnected with the small intestine ("bilio-digestive anastomosis").

Risks and chances of cure

Nowadays, the Whipple procedure is carried out in specialized centers. Thanks to their resources, for example a surgical robot as well as highly experienced surgeons, the rate of complications has dropped significantly.

Nevertheless, poor general health and serious pre-existing diseases of the patient increase the risk of complications.In cases of very small and localized tumors, which means they are only present in the head of the pancreas, the Whipple procedure can cure the patient.

Despite the chances of cure, chemotherapy is recommended following the surgery. The aim of this regimen is to eliminate any malignant cells that may have remained in the patient's body and increase the success of the surgery.

What to respect after a Whipple procedure?

As the pancreas has a key role in digesting food, it is possible that problems may occur after the surgery. But the symptoms may be very different for each individual. Pain in the upper abdomen, lack of appetite, nausea and vomiting as well as diarrhea, fatty stools and bloating may be experienced. Nearly all patients lose weight after the Whipple procedure.

Some dietary rules have been established to help prevent these symptoms. Eating 6-10 smaller meals per day rather than 2-3 larger ones is recommended. Also, patients are advised to eat slowly and to chew their food properly so that their digestive tract is not stressed by lager pieces of food.

High-fiber foods like whole grains, raw vegetables and nuts should avoided if possible, because their digestion is more challenging. Foods that increase bloating, such as onions and cabbage should also be eliminated from your diet, as they may cause pain by stretching the intestines.

Patients should also refrain from having very hot and very cold food as well as drinking large amounts of fluid at a time. Generally, it is enough for these patients to drink 1.5 liters per day. They also should drink as little fluids as they can while eating, because this can result in being full more quickly.

Certain medications are combined with dietary regulations following the Whipple procedure, that aim to replace all the enzymes needed for digestion of fats which previously have been provided by the pancreas. Particularly fat digestion is supported this way, but it also makes digesting carbohydrates and proteins easier.

Which doctors and clinics are specialists for Whipple procedure?

The Whipple procedure is performed by visceral surgeons, that means surgeons that operate on the organs of the abdominal cavity. Because of its complexity, in Germany the Whipple procedure is done in specialized centers.

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Someone in need of a doctor prefers the best medical care as possible. That's why patients like to know where to find the most excellent treatment centre. Since this question cannot be answered objectively and a serious doctor would never claim to be the best, affected people can only rely on the doctor's expertise.

We help you find an expert for your disease. All doctors and clinics listed here have been checked by us for their outstanding specialization in the area of Whipple operation (minimally invasive). They await your inquiry or treatment request.