Whipple Procedure

About Whipple Procedure

Pancreaticoduodenectomy, known as the Whipple procedure, is one of the most complex operations in abdominal surgery. It is performed mainly for cancer of the head of the pancreas and for cancers of the distal bile duct, ampulla of Vater and duodenum, and occasionally for chronic pancreatitis or benign tumors. It is named after the American surgeon Allen Whipple, who refined the operation in the 1930s, building on earlier work by the German surgeon Walther Kausch. The operation removes the head of the pancreas, the duodenum, the gallbladder, the lower bile duct and, in the classic version, part of the stomach, while the pylorus preserving variant keeps the stomach outlet. Reconstruction requires three connections to the small intestine: the remaining pancreas, the bile duct and the stomach or duodenum. Leakage from the pancreatic connection, called a postoperative pancreatic fistula, is the most important specific complication; others include delayed gastric emptying, bleeding, infection and bile leak. Mortality was very high in early decades but has fallen substantially, and many studies show better outcomes at high volume specialist centers, which has led to centralization of the operation in many countries. Pancreatic cancer has a poor overall prognosis, and complete removal of the tumor with clear margins combined with chemotherapy offers the best chance of long term survival. Chemotherapy before surgery is increasingly used for borderline resectable tumors. Laparoscopic and robotic Whipple procedures are performed at selected centers.