Also called a pancreaticoduodenectomy, the Whipple procedure is performed to address chronic pancreatitis and cancer of the pancreas, ampulla of Vater, duodenum, and the distal bile duct. It is a surgery in which the head of the pancreas, gallbladder, stomach and part of the small intestine, and the bile duct are removed. Enough of the pancreas is left to produce digestive juices and insulin.
In the beginning of the procedure, the surgeon will decide whether the tumor can be removed. The pancreas is examined by an open incision or by laparoscopic instruments. If the cancer has not spread to surrounding tissues, your surgeon will continue to perform the Whipple procedure.
The neck of the pancreas is divided in front of the portal vein. The duodenum is divided below the stomach, and farther downstream. The bile duct is divided just above the gallbladder. The pancreas, bile duct, and stomach have to be reconnected to the small intestine. This restores digestive function by re-establishing the flow of pancreatic juice from the pancreatic duct, bile from the bile duct, and food from the stomach. The specimen removed includes the head of the pancreas with the tumor and lymph nodes, a segment of duodenum, the bile duct, and the gallbladder. In some cases, the tumor has grown into the portal vein. In selected patients, a segment of the vein can be removed along with the tumor. The vein can be replaced using the internal jugular vein from the neck.
The next steps reconnect the intestinal tract. The stomach is connected to the small intestine, and the bile duct and remaining portion of the pancreas are reattached. Several tubes be implanted for postoperative care. To prevent tissue fluid from accumulating in the operated site, a temporary drain leading out of the body will be implanted.