PROCEDURE AT A GLANCE

PERIOP BRIEFING
Whipple procedure

INDICATIONS FOR PROCEDURE PATIENT POSITIONING

• Indications for a Whipple procedure, also called a The patient is placed in a supine position.2
pancreaticoduodenectomy, include
o malignant lesions of the pancreas head, ampulla of BASIC WORKFLOW FOR PROCEDURE
Vater, distal portion of the common bile duct, or To perform a Whipple procedure via an open
duodenum; and approach, the surgeon will
o pain from chronic pancreatitis located in the pancreas 1. make a midline or bilateral subcostal incision;
head and not amenable to other treatments.1 2. confirm disease resectability;
• During a Whipple procedure, the pancreas head, the 3. incise the peritoneal reflection to mobilize
duodenum, part of the jejunum, the distal portion of the duodenum;
the stomach, and the lower portion of the common 4. dissect loose areolar tissue;
bile duct are removed, after which continuity of the 5. divide the gastrocolic ligament and
pancreatic, biliary, and gastrointestinal tract systems are gastrohepatic omentum;
reestablished.1,2 6. clamp, divide, and ligate the gastroduodenal
and right gastric arteries;
7. mobilize the prepyloric portion of the
PREPARING FOR PROCEDURE stomach;
• The perioperative RN should confirm that blood typing 8. clamp the middle segment of the stomach;
and crossmatching were performed for the patient and 9. reflect the duodenum;
that blood products are available2 according to the 10. divide the common bile duct;
needs of the anesthesia professional. 11. clamp the jejunum;
• The perioperative RN should ensure basic laparotomy 12. divide the duodenojejunal flexure, pancreas,
and gastrointestinal instruments, a self-retaining and inferior pancreaticoduodenal artery;
abdominal retractor, gastrointestinal anastomosis and 13. anastomose the pancreas, bile duct, and
thoracoabdominal stapling devices, and appropriate duodenum to the jejunum;
drains and catheters are available.1,2 14. place drains;
• The patient’s abdomen is prepped from the nipples to 15. close the incision; and
midway down the thighs.2 16. apply dressings.1,2

Before Surgery After Surgery

Gall bladder
Stomach Bile duct
Bile duct
Stomach

Pancreas Small
intestine
Tumor Pancreas

Duodenum

Small intestine

doi: 10.1002/aorn.12432
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WHIPPLE PROCEDURE

POSSIBLE COMPLICATIONS
• Mortality rates for a Whipple procedure are
approximately 2 to 3 percent.6
• Up to 40 percent of patients will have at least one
postoperative complication.6
• Complications associated with a Whipple procedure
include
o infection,
o hemorrhage,
o venous thromboembolism,
o abscess,
o pseudocyst,
o biloma,
o delayed gastric emptying,
PRO CED URA L VA RIATIO NS o anastomotic leak,
• A Whipple procedure can be performed via a o temporary or permanent diabetes,
laparoscopic approach.3 o pancreatic fistula,
• The morbidity, mortality, and oncologic o nutritional malabsorption, and
outcomes associated with the laparoscopic o weight loss.1,3,6
approach are similar to those associated with the
open approach.3
• To perform a laparoscopic Whipple procedure,
the surgeon will
1. place trocars for distal resection and in the
medioclavicular line lateral to the right
rectus sheath;
2. perform dissection as in the open approach;
3. perform anastomosis with the assistance of a
laparotomy retractor ring;
4. perform hepaticojejunostomy and
pancreaticogastrostomy; and
5. staple the gastroenterostomy.2
• A Whipple procedure also can be performed
via robotic surgery, and although this is a
newer approach, it has some advantages over POSTOPERATIVE RECOVERY COURSE
laparoscopy, including greater instrument range • Patients will typically be hospitalized for one to two
of motion, three-dimensional visualization, and weeks.6
ergonomic benefits for staff members.4 • Most patients can return to normal activities after
• Other surgical options to treat pancreatic lesions approximately six weeks.3,5
or disorders include distal pancreatectomy and • Five-year survival rates after the Whipple procedure are
total pancreatectomy.3 approximately 20 percent in patients with pancreatic
• In distal pancreatectomy, the pancreas tail, a cancer and approximately 40 percent in those whose
portion of the pancreas body, and the spleen are cancer has not spread to the lymph nodes.6
removed to treat neuroendocrine tumors in the • Many patients will still require chemotherapy and
pancreas tail or body.3,5 radiation after the surgery, which improves survival rates
• In total pancreatectomy, the entire pancreas, by 10 percent.6
the gallbladder, part of the stomach and small • Stomach and bowel paralysis will likely occur for a few
intestine, and the spleen are removed to treat days postoperatively, which will require a feeding tube.6
cancer that has spread throughout the entire • Insulin injections may be needed until the pancreas
pancreas.3,5 recovers from surgical alterations.7

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WHIPPLE PROCEDURE

REF ERENCE S
1. Osborne NH, Colletti LM. Pancreaticoduodenectomy. In: Minter R, Doherty GM. Current Procedures Surgery. New York, NY:
McGraw-Hill Education; 2010:121-130.
2. Neil JA. Surgery of the liver, biliary tract, pancreas, liver, and spleen. In: Rothrock JC, ed. Alexander’s Care of the Patient in
Surgery. 16th ed. St. Louis, MO: Elsevier Mosby; 2018:342-375.
3. Whipple procedure. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/whipple-procedure/about/pac-20385054.
Published March 27, 2018. Accessed September 26, 2018.
4. Baker EH, Ross SW, Seshadri R, et al. Robotic pancreaticoduodenectomy for pancreatic adenocarcinoma: role in 2014 and
beyond. J Gastrointest Oncol. 2015;6(4):396-405.
5. Surgery for pancreatic cancer. American Cancer Society. https://www.cancer.org/cancer/pancreatic-cancer/treating/surgery.
html. Revised May 31, 2016. Accessed September 26, 2018.
6. Villines Z. Whipple procedure: what you need to know. Medical News Today. https://www.medicalnewstoday.com/
articles/318451.php. Reviewed July 17, 2017. Accessed September 26, 2018.
7. Whipple procedure. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/tests-
and-procedures/whipple-procedure/?region=on. Accessed September 26, 2018.

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