Regularly handles Whipple’s through lap
6 hr : 00 min
Pancreatic Cancer is a cancerous condition involving an uncontrolled growth and division of pancreatic cells. This may be caused by smoking, excess body weight and family history of Pancreatic cancer.
Understanding Whipples Procedure
In addition to Pancreatic head tumors, Whipple’s procedure is also done for Bile duct, Pancreatic duct and Duodenal tumors. The laparoscopic Whipple’s procedure is done for these tumors; whereas for Pancreatic head cancer, the surgeon tends to opt for the open technique. The procedure involves removal of the affected portion of duodenum (first part of the small intestines), pancreas, pancreatic or bile duct. Since the pancreas is also attached to the gall bladder, it is also affected by the cancer. So this organ is also carefully cut and removed. The remaining parts of the small intestines, pancreas and stomach are then reconnected in such a way so as to allow digestion. A drain is then placed and the skin incisions are sutured.
Although this is a complicated procedure with lots of instruments and sutures involved, the overall risk of death in this operation is less than 5%. Moreover institutions such as ours, doing this procedure on a regular basis will eventually have low complication rate coming from a high volume.
How is Whipples Procedure Performed
Accessing the Abdomen
Laparoscope is inserted through keyhole incisions and the abdominal organs are inspected for spread of cancer.
The Gall bladder and bile duct are mobilized from their position and clipped in order to avoid spillage of the stored bile. They are then carefully removed.
The first part of the duodenum, connected to the stomach may or may not be removed depending on the extent of the tumor. Pylorus is the opening of the stomach into the duodenum. So if this portion is not removed, the procedure is called “Pylorus preserving Whipples”.
Dividing the Stomach
If the tumor has spread to the stomach, the surgeon might perform a Classic Whipple’s Procedure. This involves the removal of a portion of the stomach to ensure that no tumor is left behind.
Dividing the Pancreas
The Pancreas is cut at the neck and the blood vessels behind it are exposed.
Separation of blood vessels surrounding the tumor
The branches of the vessels that supply and drain the liver and the pancreas are separated from the tumor. These are the Superior Mesenteric artery and Superior Mesenteric and Portal veins. Occasionally if these blood vessels are affected by the tumor, portions of these are also cut.
Delivering the Specimen
The entire portion of the pancreas with tumor and surrounding structures are cut off and removed out of the body, with help of a specimen bag.
The portion of the pancreas left behind is connected to the remaining part of the intestines. This re-attachment is known as anastomosis. Once re attached, digestion takes place normally.
The skin incisions are closed using sutures or staples, which are removed after 10 days.
Pancreatic cancer has a better survival rate if it is identified at an earlier stage before it has spread to nearby organs. At this stage, it can be removed completely by surgery. However, in its advanced stages, only symptomatic treatment and pain relief will be helpful. There is 20% chance that surgery at this stage may help by adding one more year to his life.
life after Whipple’s Procedure
After a Whipple’s surgery, patients are advised to undergo Chemotherapy and radiotherapy for a better survival rate.
Certain cells in the pancreas secrete insulin that help in the control of blood sugar levels in the body. When parts of the pancreas is removed, these cells are lost too. So patients who were Diabetics prior to surgery, will be advised insulin administration. There is a lesser chance that non diabetics will develop it after surgery. However close monitoring of blood sugar levels is recommended.
There is no diet restriction unless one develops diabetes.
Video: lap whipples
Whipple’s Procedure FAQ’s
In a center that does a fair number of this operation every year, the success rate is very high, and the death rate is two to five percent. For example in the last 100 operation, our death rate is two percent only. It is a major cancer operation, one of the biggest operations in the human body. So there is some worry about survival. However with modern techniques, and intensive care, that can be brought down to very small percent.
Yes. You might find that you are eating much less and your digestion may be altered because a sizable part of your pancreas is being removed. However, this is a price that one has to pay for being rid of a terrible cancer like a pancreatic head cancer.
Unfortunately there is no alternative to surgery so far. Chemotherapy and Radiation only have a minor role and that too after surgery. They cannot replace surgery.
Yes at our center we have performed close to 50 of this operation through keyholes. Although it is feasible, it takes a lot of training and practice (and patience!). We would like to point out here that only some patients with peri-ampullary cancers, are good candidates for laparoscopic whipple’s procedure. Those with large tumors, or tumors of the head of the pancreas are not candidates for keyhole surgical Whipples.
Anyway, whether it is through the keyhole or not, we to avoid blood transfusion in most patients with Whipples, and we are able to finish this operation quite quickly, thus knocking off the dangers of a long anesthesia in patients with this disease.
A week to 10 days is a best guess, although most patients leave before this time period. A small proportion need to stay a much longer period of time.
Yes, certainly. You will need supplements like Iron, Calcium, B- complex, vitamins, etc. to pick up after your Whipple’s. The truth is that our patients so far (predominantly Indian patients) seem to have quite a poor nutritional status after Whipples, and weight loss seems to be inevitable.
Yes you certainly need many other food supplements in order to increase your weight and your appetite and you’re over all general condition after this heavy surgery.
Laparoscopic Whipple’s Surgeon
Dr. J. S. Rajkumar
M.S., F.I.C.S., Dip. N.B. (SURG.), F.R.C.S. (ENG.), F.R.C.S. (EDIN.), F.R.C.S. (GLASGOW), F.R.C.S. (IRELAND), F.I.M.S., F.A.I.S., F.R.M.S. (LONDON), F.A.E. (GASTRO), F.A.C.G. (USA), F.I.C.A. (USA), F.I.A.G.E.S., Dip M.I.S. (FR.)
Dr. Prabhakaran Raju
Consultant Surgical Gastroenterolgy
M.B.B.S., M.S (GENERAL SURGERY), Mch(SGE)