Although first performed in 1898, the Pancreaticoduodenectomy is commonly named after the surgeon Allen Whipple who refined the technique in 1935. Very little has changed to the procedure since then.
The Whipple Procedure is a common operation for chronic pancreatitis, ampullary, pancreatic and bile duct cancers. The Whipple involves the resection of tumours located in the head of the pancreas, and the removal and reconstruction of a large part of the gastrointestinal tract: part of the stomach, part of the duodenum, the head of the pancreas, the bile duct and the gall bladder. Click here for information about the surgery.
The Whipple is the most extreme elective surgery (i.e. scheduled and non-emergency) that currently is performed. It’s major surgery, and not all people who have these diseases are eligible – only between 15-20% of people are eligible for surgery, and of these people 30-50% are given the go ahead.
So, if you have been selected, you are very, very lucky, and while you may not feel that you are, the procedure offers you real hope.
You will also find that you are given other statistics from your surgeon about the mortality rate that will make your toes curl; however, and this is a big however, if successful you are being given the opportunity to extend your life and even have a possible cure.
There are four major complications that can arise from surgery and can mean a longer stay in hospital:
Anastomatic leak – this is when the joins between the bowel, the liver or pancreas fail to heal properly and their contents leak where they shouldn’t. They often heal by themselves, but your post-op team will be monitoring you to measure whether a secondary surgery is needed.
Delayed emptying of your stomach – if your stomach doesn’t efficiently process food, you may need a feeding tube to ensure that you get the nutrients you need until your stomach recovers.
Chyle leak – chyle is a milky looking lymphatic fluid that may be evident in your abdominal drain after surgery, if it is seen you may need to limit the food the you eat or have a feeding tube.
Bleeding – every operation carries a risk of internal bleeding, and your team will be measuring your haemoglobin levels to ensure that you are not bleeding post-surgery. You may be scanned to find where the bleed is and may need a second operation to fix it.
My mother had 2 out of 4 complications – she spent a month in hospital having had secondary surgery, but each 24-hour period she improved. She had her operation at the Royal Stoke University Hospital – the care and expertise that she received was outstanding from the offset – she was treated with the utmost care, with dignity, respect and a healthy dose of humour.
Once you have stabilised from surgery in recovery, you will be moved to the Special Care or High Dependency Unit. The mixture of medications that are required to anaesthetise and give you pain relief will be a shock to your system, and you will more than likely be temporarily confused – hallucinations are common after surgery, but the good news is that you won’t remember this time and they will pass.
You will have drains coming out of places you didn’t even know could be drained and be sleepy from the operation. The angels that work in the unit will be monitoring everything about you – nothing is left to chance.
Amazingly, you will be out of bed the following day after your surgery. I was shocked about this, as I assumed that after such major surgery you would have bed rest, but the team will get you up and moving as soon as possible to prevent the possibility of deep vein thrombosis occurring or a chest infection. Your pain will be managed so that you are comfortable and able to be active. You will also be shown breathing exercises to do – you must do them!
To begin with, you will only be able to sip small amounts of water so that your stomach and bowel has time to heal without the additional pressure on the joins. Once you start passing wind, you will be able to increase the fluids – only follow the nurses’ instructions! Keeping hydrated is a fine balance - you don't want to drink too much and risk adding pressure to your internal stitches: sip, sip, sip and only the amount that you have been told that you can have per hour.
Your bowel may be a little slow to get moving again – it is very sensitive to being manhandled and takes a good few days to recover. Being active is also great for stimulating the bowel to function which is an indicator that you may be able to start eating again.
Depending on how your surgery has gone and whether you have experienced any complications, you will be able to introduce small amounts of food. Some people lose up to 20% of their body weight following surgery, so don’t be too alarmed at your weight loss. My mother didn’t lose as much as this, although she’s gone from a size 12/14 to a size 8/10 which is a lot, but not as dramatic as expected.
You will be tired after your operation and by the whole experience, so let yourself rest when needed – cat naps are the ideal. Your friends and family will be keen to see you, but you must try to restrict the number of visitors that you see - its exhausting being out of hospital, so if you don't feel up to visitors, take a rain check - nobody will take offence.
You may be anxious about the food that you can eat, but really the post-Whipple diet is not so bad, there are plenty of options that you can eat – just remember to take your creons and keep hydrated!
Organic foods that are free from nasties are advisable - I asked the oncologist about this and he said that there was no scientific proof that they are better; however, I just can't see how this can be the case - food laden with pesticides or food without?
If you can't stretch to organic for all of your foods, try to buy organic milk as a minimum. Cows are given growth hormones so that they produce more milk, and so the milk is infected too. Some websites say that bovine growth hormones don't affect humans, but I have found this trial from the Iranian Journal of Public Health that is published on the US National Library of Public Health confirms that they do - scientific proof!
Having read so many forums about how best to recuperate from the Whipple, the most prominent and reoccurring piece of advice seems to be to keep active – especially when you are at home. Aim to steadily increase the distance that you walk, rather than attempting a great distance to begin with.
Invest in a waterproof cover for your mattress so that you aren’t worried about any accidents!
Invest in a movement activated nightlight so that you can see where you are going if you need to use the bathroom during the night to diminish the risk of tripping!
What have your experiences been of the Whipple procedure and coming out the other side? Which foods have you found were the easiest to digest? Have you found that your tastes have changed post-surgery? What other tips do you have for people who are going to have the surgery?