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Whipple Procedure - Types, Procedure, Recovery, and Risks

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The Whipple procedure is a complex operation to remove the head of the pancreas, duodenum, gallbladder, and bile duct. Read the article to know more.

Written by

Dr. P. Saranya

Medically reviewed by

Dr. Jagdish Singh

Published At September 15, 2022
Reviewed AtJanuary 2, 2024


The pancreas is an organ that lies in the upper abdomen below the stomach. The pancreas secretes enzymes that help digest food, especially fats and protein. The pancreas also secretes hormones that maintain blood sugar. The Whipple procedure is used to treat cancers and other conditions of the pancreas, intestine, and bile duct. It is the most often used surgery to treat pancreatic cancer confined to the head of the pancreas. The procedure is named after Allen Whipple, the first surgeon to perform this procedure.

Why Is the Whipple Procedure Done?

Whipple procedure or pancreaticoduodenectomy is done to treat:

  • Pancreatic cancer.

  • Pancreatic cysts.

  • Pancreatitis.

  • Bile duct cancer.

  • Small bowel cancer.

  • Trauma to the pancreas or small intestine.

  • Neuroendocrine tumors.

  • Other tumors or conditions involve the pancreas, small intestine, and bile duct.

The goal of the Whipple procedure is to remove the tumor and prevent it from spreading to other organs.

What Are the Various Ways of Whipple Surgery?

  • Open Surgery: This is the most common approach for pancreaticoduodenectomy. The doctor makes an incision in the abdomen during the open surgery to access the pancreas.

  • Laparoscopic Surgery: Several small incisions are made in the abdomen during laparoscopic surgery. The surgeon inserts special tools through the small cuts to perform the surgery. It is a minimally invasive surgery. They have some benefits, like low blood loss and quicker recovery.

  • Robotic Surgery: It is also a type of minimally invasive surgery in which the surgical tools are attached to a robot. A surgical robot is more effective in using corners and tight space tools.

What Are the Types of Whipple Procedures?

There are two common types of Whipple procedure - the conventional Whipple procedure and the pylorus-sparing Whipple procedure.

  • The conventional Whipple procedure involves the removal of the head of the pancreas, gallbladder, duodenum, bile duct, and a portion of the stomach. Then, the remaining stomach and pancreas are reattached to the digestive tract to restore normal function.

  • The pylorus-sparing pancreaticoduodenectomy is a modified Whipple's procedure. In this procedure, only part of the duodenum is removed, and the pylorus (part of the stomach that connects to the duodenum) is spared. This procedure is also known as the mini-Whipple procedure.

How to Prepare for the Whipple Procedure?

Before undergoing the Whipple procedure, individuals should talk with the surgical team about what to expect before, during, and after the surgery, along with possible risks. The team will also discuss how the surgery might affect their life. They may suggest treatments like chemotherapy or radiation before or after the Whipple procedure. The type of procedure individuals will have depends on overall health, and they might need additional tests before the surgery to ensure they are healthy enough for the operation.

  • Avoid food and drinks eight hours before the procedure.

  • Quit smoking at least two weeks before the procedure.

  • Inform the doctor about the medications and previous allergies or reactions to medications.

  • The patient wears a surgical gown during the procedure.

  • An intravenous line is put into the vein in the arm to inject fluids and medications.

  • A urinary catheter is inserted into the bladder to drain urine during and after the surgery.

What Happens During Whipple Procedure?

Whipple procedure is a complex procedure with the risk of major complications. It takes a lot of skill and experience to perform this surgery. The American Cancer Society suggests that the procedure be done at a hospital by a surgeon who performs 15 to 20 pancreas surgeries per year. The Whipple procedure is done under general anesthesia. The surgery takes up to four to 12 hours, depending upon the approach and the severity of the condition.

The surgeon makes an incision in the abdomen to access the internal organs. In pancreatoduodenectomy, the head of the pancreas, the beginning of the small intestine (duodenum), the gallbladder, and the bile duct are removed. In addition, the Whipple procedure sometimes involves removing a portion of the stomach or nearby lymph nodes. Other surgeries involving the pancreas are also done depending on the patient's condition. The surgeon then reconnects the remaining parts of the pancreas, stomach, and intestine to allow normal digestion of food.

What to Expect After a Whipple Procedure?

Patients typically remain in the hospital for eight to ten days post-pancreaticoduodenectomy, during which doctors monitor for complications and gradually reintroduce drinking and eating. In the days following surgery, extensive tests are conducted to check for complete cancer removal and the presence of cancer cells in lymph nodes. The common complications include:

  • Delayed gastric emptying is a common complication after a Whipple procedure, where the stomach takes too long to empty. Generally, after seven to ten days, the stomach starts to empty sufficiently for healing. If delayed gastric emptying persists, the patient may need feedings through a tube or vein for several weeks.

  • The most serious potential complication is abdominal infection from leakage where the pancreas connects to the small intestine, known as a pancreatic leak or pancreatic fistula. This occurs in about 10 percent of patients and is usually managed with draining tubes and antibiotics, with many patients requiring nutritional support.

Other risks associated with pancreaticoduodenectomy include:

  • Bleeding at the surgical site.

  • Diabetes, temporary or permanent.

  • Leakage (where the pancreas is connected to the small intestine).

  • Difficulty digesting some foods.

  • Weight loss.

  • Bowel changes.

  • Constipation.

How Does Recovery Occur After the Whipple Procedure?

This surgery often requires a week-long hospital stay. Most Whipple surgery recovery occurs four to six weeks after surgery, and the patient returns to normal activities. Following the procedure, the patient will be on a clear, liquid diet for a few days, after which the doctor will slowly introduce solid foods. Soft solid foods that are easily digestible should be given.

Whipple surgery recovery depends on the physical condition of the patient and the severity of the disease. Since Whipple surgery recovery is slow and painful, painkillers are prescribed to manage pain. Very few people survive pancreatic cancer. Whipple procedure increases the long-term survival rate of pancreatic cancer by 25 percent.

What Are the Other Treatments Done With the Whipple Procedure?

Sometimes patients receive treatment before the surgery. This could be chemotherapy, radiation therapy, or both. Treatment is given before surgery is called neoadjuvant therapy. Treatment given after the surgery is called adjuvant therapy. The main aim is to kill the small cancer cells present to prevent the recurrence of tumors.

Following are some procedures related to pancreatoduodenectomy:

  • Surgery for Tumors in the Body and Tail of the Pancreas: Surgery to remove the body and tail of the pancreas is called distal pancreatectomy. During this procedure, the surgeon may sometimes also remove the spleen.

  • Surgery to Remove the Entire Pancreas: This surgery is called total pancreatectomy. Normal life without a pancreas is possible, but the patient will need lifetime Insulin and enzyme replacement.

  • Surgery for Tumors Affecting Nearby Blood Vessels: A Whipple procedure can not be done if the tumor involves the nearby blood vessels.


Whipple procedure is the primary surgical treatment for pancreatic cancer involving the head of the pancreas and has not spread beyond the pancreas. Among the common cancers, pancreatic cancer has one of the poorest prognosis. However, the Whipple procedure increases the survival rate of people with pancreatic cancer.

Dr. Jagdish Singh
Dr. Jagdish Singh

Medical Gastroenterology


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