Whipple Procedure: What to Expect on the Day of Surgery

A Whipple procedure (pancreaticoduodenectomy) is a type of surgery that involves several different procedures at once. It’s performed to treat pancreatic tumors and other pancreatic conditions, as well as disorders of the intestines and bile ducts.

A Whipple procedure lasts four to six hours and is performed under general anesthesia. It requires a hospital stay of seven to 10 days. Prepare by taking a look at what will happen on the day of surgery.

Before the Surgery

Follow your surgeon’s advice on when to stop eating before your surgical procedure is scheduled. Most often, the surgeon will instruct you to quit drinking and eating the night before your surgery. This includes abstaining from any type of hard candy, gum, and water. When you wake up in the morning, it's important to continue to abstain from food and drink.

You may be ordered to drink a specific type of mixture aimed at emptying the bowels; this may be a solution called ClearFast PreOp, or some other brand. Again, follow the specific advice of your healthcare provider.

Take Medications as Ordered

Your healthcare provider may have ordered that you take certain medications with very small sips of water. Commonly, drugs such as high blood pressure medications are ordered to be taken, even on the day of surgery. But, be sure to take only the medications that your practitioner has ordered.

Shower With Hibiclens

Many healthcare providers ask that patients shower with Hibiclens immediately before leaving for the hospital. Hibiclens (chlohexadine) is an antiseptic soap that is often ordered to use the night before, and then again the morning of surgery.

Use the Hibiclens gently over your entire body from your neck to your hips (but avoid use on the face, hair or genital area). Just use normal soap for cleansing the face and genital area, and use your regular shampoo to wash your hair.

After applying the Hibiclens, move away from the water stream in the shower to allow the solution to stay on the body for a while before rinsing it off with warm water. Dry off with a clean towel.

Avoid the use of any type of lotion, cream, perfume, essential oils, makeup. deodorant or cologne after your shower. After your shower, put on some comfortable clothing to wear to the hospital. Avoid wearing any type of metal objects (such as jewelry or piercings). Leave your valuables at home.

At the Hospital

Once you are admitted to the hospital on the day of surgery, you’ll be asked to remove your contacts if you wear them (be sure to wear your glasses to the hospital instead of contacts), dentures, hearing aids, wigs, as well as religious items (such as prayer beads).

Be prepared to be asked about your identity and your surgical procedure, perhaps several times before your surgery. Often, hospital facilities have policies in place to ensure quality (such as being sure that the right patient and the right procedure is properly identified).

After being admitted to the hospital, you will be taken to an area where an admissions nurse will give you a hospital gown. Some facilities will also supply a robe and non-skid socks to wear, but you should pack your own robe and socks/slippers if you are unsure of the policy at the facility.

Meet With the Nurse

When you meet with the nurse on the day of surgery, be sure to explain which medications you took after midnight (and the dosage as well as the time you took them) on the day of your procedure. 

Be sure to mention any patches, topical medications (on the skin) or sublingual (under the tongue) drugs. It’s important to report any natural or herbal supplements (including vitamins) as well.

The admissions nurse will start an intravenous (IV) line into your vein (usually in the hand or arm) so that IV fluids and medications can be given before, during, and after the procedure. If the IV is not started by the nurse, the anesthesiologist (a healthcare provider trained in administering anesthesia) will start the IV.

Meet With the Anesthesiologist

Before your Whipple procedure, the anesthesiologist will meet with you to review the type of anesthesia you will be having during surgery, and to go over any problems you’ve had from anesthesia in the past (if any). The anesthesiologist will also gather a health history and perhaps discuss various routes of anesthesia (such as IV, spinal anesthesia, and more).

The epidural catheter (a thin tube introduced to inject medication around the dura mater of the spinal cord) is often used to administer pain medication after surgery.

The anesthesiologist functions to do several things before surgery, including:

• Answering questions about anesthesia
• Selecting the right type of anesthesia for each patient, based on individual needs
• Educating patients on the safety and risks of anesthesia

Once you have checked in with the admitting nurse, you may be able to have visitors while waiting for your Whipple procedure (depending on your facility's specific policy on visitors).

Premedication

Some anesthesiologists will order medication to be given (via IV or possibly via intramuscular injection) before surgery. There are several goals of premedication administration, including:

• To help lower anxiety and/or pain before surgery
• To potentiate the reduction of secretions before surgery
• To promote the amnesia (forgetfulness) effect of anesthesia
• To help lower the volume of contents in the stomach
• To lower the incidence of nausea and vomiting after surgery
• To enhance the effects of anesthesia during surgery

The practice of administering premedication—which used to be a standard medical practice—has evolved over the past 30 years. Today, the traditional use of medications such as morphine before surgery is not often given; this is because of the advent of many new anesthetic medications that are said to have fewer side effects and a faster onset of action.

Move to the Operating Room

You may be escorted to the operating room via stretcher, or in some facilities, patients are allowed to walk if they are able to. Some facilities will place compression boots on the lower legs. These boots are inflatable and as they gently inflate and deflate, they help to promote blood flow to the lower legs.

Once you are lying on the table in the operating room, the anesthesiologist will begin to administer the anesthesia to put you to sleep before your Whipple procedure.

During the Surgery

The Whipple procedure typically takes an estimated:

• 4 to 6 hours to complete the procedure
• 24 to 48 hours spent in surgical intensive care
• 7- to 10-day hospital stay
• 6 to 8 week postoperative recovery period

The procedure is done via an open technique, meaning that a large incision is made into the abdomen, extending from one side of the abdomen to the other. This means that a large surgical scar will be present after recovery.

Once the anesthesia takes effect and you are asleep, a breathing tube will be placed into the mouth and inserted into the trachea (windpipe) to assist you in breathing during the operation.

You will also have a Foley catheter (a hollow tube placed through the urethra to the bladder) to drain the urine out during and after the procedure.

Laparoscopy

The surgeon may make a few smaller incisions to place a very small video camera inside the abdomen. This allows the surgeon to get a good view of your organs to check for areas that cancer may have spread outside of the pancreas. The use of a small camera via insertion through very small incisions is called a diagnostic laparoscopy.

Whipple Procedure

If the laparoscopy confirms that the surgery is appropriate, a large incision will be made to continue performing the Whipple procedure and to remove the tumor.

A pancreatoduodenectomy (Whipple procedure) involves several surgical procedures during the same operation. The Whipple procedure involves:

• Removal of the gallbladder
• Removal of the head of the pancreas
• Removal of a section of the bile duct
• Removal of a section of the small intestine (duodenum)
• Removal of part of the stomach (may be required if the surgeon finds that the cancer has spread).

After the organs are removed, reconstructive surgery is required. The reconstruction is performed during the Whipple procedure. It involves:

• Attachment of the stomach to the small intestine
• Attachment of the tail of the pancreas to the end of the small intestine
• Attachment of the shortened remainder of the bile duct to the small intestine

After the Surgery

Once your Whipple procedure is complete, the surgeon will close the incision using staples or sutures. You may also have Steri-Strips (thin segments of surgical tape) covering your incision. The incision will be covered with some type of dressing.

The breathing tube will be removed in the operating room, after the anesthesiologist stops administering anesthesia.

Post-Anesthesia Care Unit (PACU)

When you wake up after your Whipple procedure, you will be in the post-anesthesia care unit (PACU). This is a place for close monitoring after surgery. A nurse will closely monitor your vital signs (blood pressure, pulse, temperature, and respiration) as well as your oxygen levels.

You may be receiving oxygen through an oxygen mask. Your compression boots will be on, and your Foley catheter will still be in place.

Pain Medication

During your postoperative (after surgery) recovery period, you will receive pain medication via your IV or epidural catheter. You will be able to control the amount of pain medication you get, using a patient-controlled analgesia (PCA) device. PCA is a method of allowing a person to administer their own pain relief, via a preprogrammed IV infusion device.

Tubes and Drains

When you wake up after surgery, you will probably have various types of tubes and drains. Your healthcare provider should explain to you exactly which types to expect after a Whipple procedure. Common types of tubes and drains include:

• Foley catheter: This tube is inserted through the urethra into the bladder to drain urine from the bladder. The Foley is usually removed on day two after surgery. 
• Nasogastric (NG) tube: A nasogastric tube is inserted into the nose, then advanced downward into the stomach. An NG tube is used to help drain the fluid (such as saliva) that collects in the stomach to prevent post-surgical vomiting. The NG tube will likely be removed the day after your surgery.
• Abdominal drainage tube: This tube is placed during surgery to drain fluid from the area. Wound drainage tubes are usually removed within a few days after surgery.

Note, you may be discharged with drains still in place, if so, the discharge nurse will give you instructions on how to take care of drains or tubes.

Depending on the hospital's protocol, you may be able to receive a limited number of visitors in the PACU, (usually within an hour and a half after you are transferred to PACU from the operating room.

Transfer to a Hospital Room

After an overnight stay in the PACU, you will be transferred to a regular hospital room, provided that your condition is stable. The average length of hospital stay is six days after having a Whipple procedure; so you will be in a regular hospital room for approximately five more days after the PACU stay.

Tips for a speedy recovery after your Whipple procedure include:

• Start moving around as soon as possible, the sooner you begin walking (the fday after surgery), the quicker you will be able to resume normal activities. Walking and moving around also helps to prevent blood clots and pneumonia after surgery.
• Be sure to follow the hospital’s falls prevention protocol. Ask for help getting out of bed (particularly the first time you get up), wear skid-proof slippers or socks, and more.
• Inform the nurse if pain is unresolved with pain medication. Immediately after your Whipple procedure you will get pain medication via your IV line or epidural catheter; once you are able to eat, you will be able to take pain pills by mouth.
• Use your incentive spirometer (a device aimed at preventing pneumonia after surgery) as instructed, usually 10 times per hour, the day of surgery. Also, perform coughing and deep breathing exercises as instructed to aid in the prevention of pneumonia after surgery.
• You won’t be able to eat or drink any fluids on the day of surgery; you will slowly go back to drinking and eating a few days after a Whipple procedure. Your digestive system needs time to heal before it can begin to digest food again. Your surgical team will instruct you specifically on what and when to eat and drink after surgery.