Whipple Procedure in Bhubaneswar

Approximately 20% of people with pancreatic cancer are eligible for the Whipple procedure and other surgeries. This procedure is usually considered for tumours located at the head of the pancreas that have not spread to other parts of the body. The Whipple procedure can also be used to treat conditions such as:

• Pancreatic cysts
• Pancreatitis (inflammation of the pancreas)
• Cancer in your upper small intestine
• Damage to your pancreas or small intestine
• Cancer between the bile and pancreatic ducts (ampullary cancer)
• Bile duct cancer
• Neuroendocrine tumours
   

Recovery after the Whipple Procedure involves a hospital stay of about 1 to 2 weeks, followed by a period of several months for full recovery and adjustment to dietary changes.

Following the Whipple Procedure, patients usually stay in the hospital for 7 to 14 days, depending on their recovery progress and any complications. After discharge, it can take several weeks to months to fully recover and resume normal activities. Close monitoring by healthcare providers is essential during the initial recovery phase.

At Manipal Hospitals, the Whipple procedure can be carried out using various surgical methods:

• Open surgery: Performed through a midline incision on the abdomen. This approach allows the surgeon to confirm that the tumour has not spread to nearby structures before its removal.  
• Laparoscopic surgery: This minimally invasive procedure is performed using 4 to 5 smaller incisions in your abdomen, through which a laparoscope and other special instruments are inserted to remove the tumour growth. 
• Robotic surgery: Also minimally invasive, this technique is performed using advanced surgical instruments controlled by the surgeon from a console. The robotic arm mimics human hand movements with high precision.

Whether performed through open surgery or minimally invasive methods, the Whipple procedure requires extensive surgical training and proficiency. Manipal Hospitals have one of the most experienced teams of surgeons in the country specialising in this procedure.

Immediate Risks (During Surgery and Early Post-op):

• Infection: Despite antibiotic prophylaxis, there is a risk of surgical site infections or infections in the abdomen.
• Bleeding: Significant bleeding can occur during or after surgery, requiring transfusion or re-operation.
• Leakage from Surgical Connections: The connections (anastomoses) made during surgery (between the pancreas, bile duct, and intestines) may leak digestive fluids.
• Pancreatic Fistula: This is a specific complication where pancreatic fluids leak into the abdominal cavity, potentially leading to infection or delayed healing.
• Complications related to Anesthesia: As with any major surgery, there are risks associated with anaesthesia, such as reactions or complications related to being under anaesthesia for an extended period.

Long-term Risks and Complications:

• Digestive Difficulties: Altered anatomy can lead to difficulties in digestion and absorption of nutrients. Patients may experience diarrhoea, bloating, or malnutrition, requiring dietary adjustments, enzyme supplements, or medications.
• Diabetes: Removal of part of the pancreas can affect insulin production, potentially leading to diabetes requiring ongoing management with insulin or other medications.

Before your surgery, the surgeon and anaesthesiologist will meet with you and your family in the preoperative holding area to address any last-minute questions. The anaesthesia team will then take you to the operating room and administer intravenous (IV) medications to put you to sleep. The anaesthesiologist will also place a breathing tube to provide you with oxygen during the operation. The surgical team will also insert additional IV lines, a bladder catheter, and a stomach tube after you are asleep.

After the surgery, most patients will have a small tube in their nose to drain the stomach, an abdominal drain, and a bladder drainage tube. These are almost always removed before hospital discharge.
 

Eligibility for a Whipple Procedure is determined based on several factors:

• Overall Health: Patients should generally be in good health to withstand major surgery.

• Stage of the Disease: The procedure is most commonly performed for cancers in the head of the pancreas or certain benign conditions affecting the pancreas, bile duct, or duodenum.

• Extent of Involvement: Preoperative imaging (like CT scans or MRI) and sometimes biopsies help determine if the cancer is localised and if adjacent organs are involved.

• A multidisciplinary team, including surgeons, oncologists, radiologists, and gastroenterologists, assesses each case to ensure the procedure is appropriate and the patient is prepared physically and emotionally.

After the procedure, you will be placed for a few days in the ICU unit for close monitoring. The nursing staff will regularly monitor your progress and check for signs of infection or complications. The next day after the surgery, the nasogastric tube is usually removed, and within a couple of days, the urinary catheter is also removed. Gradually, you will be able to walk with assistance. 
 

Long-term effects can significantly impact patients' daily lives:

• Digestive Changes: Patients may need to adjust their diet to manage changes in digestion and nutrient absorption. This often involves smaller, more frequent meals and potentially enzyme supplements.

• Nutritional Considerations: Monitoring nutritional status and possibly adjusting vitamin and mineral supplementation is common.

Initially, you may only be able to consume small amounts of easily digestible food. You may need to take enzyme pills with meals to assist with digestion, either on a short-term or long-term basis. Before discharge, you will receive instructions on how to maintain a proper diet, including recommended supplements. Diarrhoea is common for the first few months as your rearranged digestive tract fully recovers.
 

Follow-up care is tailored to each patient’s needs but typically includes:

• Regular Monitoring: Scheduled visits with the surgical team for physical exams, blood tests (including tumour markers), and imaging scans (like CT or MRI) to detect any recurrence of cancer or complications.

• Nutritional Support: Dietitians may provide guidance on dietary changes and supplementation.

• Management of Diabetes: If diabetes develops, ongoing monitoring and management with medications or insulin therapy are necessary.

Recovery times vary depending on the wound healing and post-operative complications. You may spend about a week in the hospital, including 1-2 days in the ICU and 5-6 days in the ward. After a few weeks of recovery, you should be able to lead a normal life.
 

Returning to normal activities after the Whipple Procedure depends on individual factors such as overall health, extent of surgery, and any complications during recovery. Initially, patients typically spend about 1-2 weeks recovering in the hospital, closely monitored for signs of healing and any potential complications. After discharge, a gradual recovery process begins, focusing on managing pain, restoring strength, and adapting to potential changes in digestion and diet. Most patients can start light activities like walking within a few weeks, gradually increasing their level of physical activity as tolerated. 

As with any surgery, complications can occur. Approximately one-third of patients who go through the Whipple procedure experience complications. Among the risks involved both during and following surgery are:

• Bleeding within the abdomen or at the site of the incision
• Infections at the incision site and within the abdominal cavity
• Eating difficulties due to delayed gastric emptying 
• Leakage from the pancreatic or bile duct connections
• Post-operative pneumonia
• Diabetes
• Recurrence of cancer

Most of these complications can usually be managed by your surgeon without requiring additional surgery.
 

After undergoing the Whipple Procedure, additional treatments like Chemotherapy or Radiation therapy may be advised depending on the specific characteristics of the disease. For pancreatic cancer, adjuvant Chemotherapy is often recommended to target any remaining cancer cells and reduce the risk of recurrence. Radiation therapy may also be used either before surgery (neoadjuvant) to shrink tumours or after surgery (adjuvant) to further eliminate cancer cells. 

These treatments aim to improve overall outcomes by addressing microscopic diseases that may not be visible during surgery alone. The decision for additional therapy is based on factors such as tumour stage, presence of lymph node involvement, and the overall health of the patient, ensuring a comprehensive approach to managing and potentially curing the disease.

The majority of patients come back for a postoperative follow-up visit within three weeks after their surgery. However, contact your surgical team immediately if the following happens:

• You get loose or open stitches 
• You develop a fever
• Your incision looks red, feels warm, leaks pus, or there is an increase in pain 
• You are having irregular bowel movements
   

The Whipple procedure is a complex operation best performed by highly skilled and experienced surgeons. At Manipal Hospitals, our experienced surgeons can discuss the benefits and risks with you and let you know how the surgery may impact your daily life. We are committed to providing you with the highest standards of care to support your recovery and well-being.