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what is a whipple's

what is a whipple's
ivor lewis
frey's procedure
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the pancreas
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The Whipple Procedure
Also called a pancreaticoduodenectomy, which is generally the removal of the gallbladder, common bile duct, part of the duodenum, and the head of the pancreas.This operation was first described by .Dr. Alan O. Whipple of New York Memorial Hospital . Since that time, there have been many modifications and improvements of the procedure.

why do people need a whipples

This is a complex and major operation to remove the head (the ‘right end’) of the pancreas gland. This procedure is carried out in patients who:
- Have a suspicious lump in the head of the pancreas gland (including cancer);
- Have a blockage in the terminal part of the bile duct (often first becoming apparent after the patient develops jaundice).


treatment results and risks

Can Pancreatic Cancer be treated surgically? How?

By the time a patient is diagnosed with pancreatic cancer, the disease is often already in an advanced stage. For this reason, a large majority of patients are not candidates for surgical treatment. We are making advances in understanding the early stages of this disease that, in time, will help us to detect more pancreatic cancers while they are still operable.

Surgery may be suggested as a potentially curative treatment or as a palliative measure to improve the patient's quality of life. Before reviewing the surgical procedures, it is important to emphasize that every patient has a unique case that should be discussed in detail with your healthcare providers.When is surgery possible?

Generally if the cancer is localized, surgical treatment, by resection or removal of the tumor, can be pursued. This means that the cancer has not spread to any blood vessels, distant lymph nodes or other organs, such as the liver or lung. These characteristics are determined through various complimentary diagnostic techniques. If the cancer has spread to nearby lymph nodes that are routinely removed during a given surgical procedure, surgery will usually still be possible. Also, recent developments have allowed for surgical replacement of the portal vein, a major blood vessel that carries blood to the liver.

What excludes surgery as a treatment option?

Generally, if the cancer is found in distant lymph nodes, other organs or blood vessels, surgical resection will not be pursued. If this is the case, the doctors and/or nurses will discuss possible medical treatments and/or palliative procedures. Surgery may still be considered to alleviate some symptoms and make the patient more comfortable (see bypass) but not as a curative measure.

What types of surgical procedures are performed to treat pancreatic cancer?

This depends where the tumor is located within the pancreas. The five parts of the pancreas are reviewed below. For a detailed explanation and illustrations of a particular surgical procedure, click on the name of the procedure.

Cancer in the Head, Neck or Uncinate Process of the Pancreas:
The Whipple Procedure

Cancer in the Body or Tail of the Pancreas:
Distal Pancreatectomy and Splenectomy

How can palliative surgery improve quality of life?

Double By-pass- A palliative surgical procedure to alleviate jaundice, nausea and vomiting for patients with advanced tumors in the head of the pancreas. The double bypass involves a bypass to the bile duct and a bypass to the stomach. Often a celiac nerve block is also performed.

Celiac Nerve Block- Can be done during a surgical procedure or as a separate non-surgical procedure. This improves tumor-associated pain and may reduce the need to use pain medications.

where the organs are found


the bits that are removed



how it all fits together

Normal results

Unfortunately, pancreatic cancer is the most lethal form of gastrointestinal malignancy. However, for a highly selective group of patients, pancreatectomy offers a chance for cure, especially when performed by experienced surgeons. The overall five-year survival rate for patients who undergo pancreatectomy for pancreatic cancer is about 10%; patients who undergo pancreaticoduodenectomy have a 4-5% survival at five years. The risk for tumor recurrence is thought to be unaffected by whether the patient undergoes a total pancreatectomy or a pancreaticoduodenectomy, but is increased when the tumor is larger than 3 cm and the cancer has spread to the lymph nodes or surrounding tissue.

After total pancreatectomy, the body loses the ability to secrete insulin, enzymes, and other substances, therefore, certain medications will be required to compensate for this. In some cases of pancreatic disease, the pancreas ceases to function normally, then total pancreatectomy may be preferable to other less radical forms of the operation.


The mortality rate for pancreatectomy has improved in recent years to 5-10%, depending on the extent of the surgery and the experience of the surgeon. studies  found that only nine patients, or 1.4%, died from complications related to surgery.

There is still, however, a fairly high risk of complications following any form of pancreatectomy.  The most devastating complication is postoperative bleeding, which increases the mortality risk to 20-50%. In cases of postoperative bleeding, the patient may be returned to surgery to find the source of hemorrhage, or may undergo other procedures to stop the bleeding.

One of the most common complications from a pancreaticoduodenectomy is delayed gastric emptying, a condition in which food and liquids are slow to leave the stomach. This complication occurred in 19% of patients. To manage this problem, many surgeons insert feeding tubes at the original operation site, through which nutrients can be fed directly into the patient's intestines. This procedure, called enteral nutrition, maintains the patient's nutrition if the stomach is slow to recover normal function. Certain medications, called promotility agents, can help move the nutritional contents through the gastrointestinal tract.

The other most common complication is pancreatic anastomotic leak. This is a leak in the connection that the surgeon makes between the remainder of the pancreas and the other structures in the abdomen. Most surgeons handle the potential for this problem by assuring that there will be adequate drainage from the surgical site.