Whipple Procedure: How to Prepare

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When preparing for the Whipple procedure (pancreaticoduodenectomy surgery), it’s important to know what type of facility you will be having the procedure at, what to expect before the procedure, what medications to take (and which ones to withhold), and about certain lifestyle changes that will help to speed recovery after the procedure.

Location

A Whipple procedure is a complex operation that takes place in a hospital setting. You can expect a total stay of six to 10 days in the hospital. The surgery itself will take four to six hours. You will generally be transferred to a regular hospital room after a night in the intensive care unit (ICU)

After having a Whipple procedure, you should expect to awaken in the ICU. When a person is in the ICU, this indicates that very close monitoring is required.

The ICU looks quite different from a regular hospital room, with various types of special equipment such as defibrillators (devices that deliver an electrical shock to the heart when the heart stops beating normally), patient monitors, ventilators (machines to help those who stop breathing) CPAP systems (equipment for those with sleep apnea), and more.

Preparing for Whipple surgery
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What to Wear

When preparing for a Whipple procedure, wear clothing that is comfortable and loose-fitting. Once you get checked into the hospital (through the admissions department) you will be taken to the preoperative area of the hospital and given a hospital gown and an ID bracelet.

Things to keep in mind when planning for a Whipple procedure include:

  • Remove contact lenses (wearing them during surgery can potentially damage your eyes).
  • Refrain from wearing any metal objects (such as jewelry or body piercings) because some equipment used during surgery could cause burns when touching metal objects.
  • Refrain from donning lotions, body creams, deodorant, makeup, powder, body cologne, or perfume.
  • Remove hearing aids, dentures and/or any prosthetic devices before surgery.

Although religious articles (such as prayer beads) may be comforting to have with you, these items won’t be allowed in the operating room.

Food and Drink

Talk to your surgical team about when to stop eating and drinking the night before your Whipple procedure. Some facilities instruct patients to refrain from eating or drinking anything after midnight on the day of the procedure. This is important because it helps the body to better prepare for anesthesia.

Your surgeon may instruct you to take medications for asthma, blood pressure, heart mediation, seizure medication with a very small sip of water the morning of your surgery. Be sure to confirm exactly which medications you should take the day of surgery before the procedure.

Medications

Some types of medications should be stopped before having a surgical procedure because they can increase the risk of complications, such as bleeding. Be sure to tell your surgeon if you take:

  • Any type of prescription medication that has been prescribed by a healthcare provider (don’t forget to mention topical creams or patches)
  • Over-the-counter medications (including drugs purchased at a drug store or elsewhere), including topical creams, ointments, or patches
  • Dietary supplements, including herbal supplements, vitamins, minerals, or natural or home remedies
  • Blood thinners such as aspirin, heparin, warfarin (Coumadin), clopidogrel (Plavix), enoxaparin (Lovenox), rivaroxaban (Xarelto), or others

Miscellaneous Information to Report

In addition to reporting any type of medication you are taking, it’s important to mention other important health factors to your surgeon before your Whipple procedure, these include:

  • If you have a heart device such as a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or any other
  • If you have had an adverse reaction to anesthesia in the past
  • If you are allergic to any medications or materials used in the hospital (such as latex gloves)
  • If your religion does not permit you to have a blood transfusion (or if you are unwilling to receive a blood transfusion for any other reason)
  • If you have sleep apnea (and if you use a CPAP machine)

Some types of sleep apnea can cause complications before and after a Whipple procedure. If you have sleep apnea and you use a CPAP machine, bring it with you the day of your surgery.

Timetable Before a Whipple Procedure

Here are some general recommendations regarding when to stop taking specific types of medications before a Whipple procedure. But, always check with your surgery team and follow your surgeon's exact advice on what medications to take before surgery and when to stop taking certain medications in preparation for Whipple surgery.

10 Days Before Your Surgery

If you take vitamin E, stop taking it 10 days before your Whipple procedure is scheduled; this is because vitamin E may cause bleeding.

7 Days Before Your Procedure

Quit taking blood thinners seven days before your scheduled Whipple procedure. Withhold any type of natural or herbal remedies or supplements seven days before your surgery (including vitamins and other dietary supplements, herbal tea, or powdered supplements).

2 Days Before Your Procedure

Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin) or naproxen (Aleve), at least two days before your scheduled Whipple procedure because NSAIDs can cause bleeding.

1 Day Before Your Surgery
Shower with Hibiclens skin cleanser the night before surgery; this is a solution that helps to kill germs for 24 hours after use. This will help to lower your overall risk of infection after surgery. 

What to Bring

Items that you should pack for your hospital stay include:

  • Tennis shoes that lace up (to allow for any swelling in the feet)
  • Your CPAP (sleep apnea) machine if you have one
  • Legal documents such as advance healthcare directives, living wills, or a healthcare proxy (if you have completed them). These are legal documents denoting who can legally make healthcare decisions for you and what your choices for medical care are (such as do not resuscitate [DNR] orders) in the rare case that you would become unconscious or otherwise incapacitated after the surgery.
  • A small amount of money (for small cash purchases at the hospital gift store)
  • A suitcase or bag for personal items that are not allowed in the operating room (such as you’re your cellular phone and charger, dentures, eyeglasses, hearing aids, prosthetics, a wig, or religious articles).

Preoperative Lifestyle Changes

A Whipple procedure is a major medical operation that impacts how a person can digest food. People with pancreatic cancer (and other conditions that may require a Whipple procedure) are known to lose a lot of weight.

Your doctor may prescribe pancreatic enzyme supplements before your surgery to help your body adapt to the digestive problems involved in having a serious pancreatic condition.

Diet
In addition to taking pancreatic enzymes, it’s important to eat a healthy, balanced diet to strengthen the body before surgery. It’s advisable to consult with a dietitian to get advice on eating healthy for weight gain (particularly if you’ve lost a significant amount of weight). Your healthcare provider can write an order for a consultation with a dietician.

Exercise

If your current lifestyle involves a pattern of regular exercise, continue your workouts as usual, before your procedure. If you don’t exercise, consult with your healthcare provider before starting any type of workout routine and follow your doctor’s advice.

It’s usually advisable to try to move as much as possible, starting with low-intensity exercise (such as walking) for short distances, then, build up each day as your body adapts to exercising for longer periods of time.

Ultimately (with your physician’s approval) a regular aerobic exercise routine is advisable each day, such as walking briskly, swimming, or biking.

Never attempt any type of exercise without the approval of your healthcare provider. What is appropriate will depend on your individual condition.

Smoking
If you are a smoker, stop smoking as soon as possible. Smoking can lead to a higher risk of serious complications during and after surgery, including heart and breathing problems. If you can’t quit long-term, consider quitting (or at least reducing the amount you smoke) for as many days as possible before your scheduled surgery.

Quitting smoking for even a few days before surgery (and staying smoke-free after surgery) was found to help lower risks of complications, while hastening the recovery period postoperatively.

Alcohol Consumption

Drinking alcohol regularly can increase complications during and after your Whipple procedure (such as bleeding, heart problems, and infection). For heavy drinkers, stopping suddenly could result in serious health issues (such as seizures, delirium or even death).

Be sure to have a conversation about how much you drink with your surgeon before your surgery is scheduled. Many medical professionals advise that once your procedure date has been scheduled, it's a good time to try to stop drinking.

If you have early withdrawal symptoms such as headache, nausea, anxiety, or insomnia when trying to quit, talk to your healthcare provider right away. Your healthcare provider can prescribe medication that can help prevent complications of suddenly quitting drinking.

If you are unable to quit drinking, talk to your surgery team. Be aware that any information you share about drinking will be kept confidential.

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Article Sources
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  1. MUSC Health (Medical University of South Carolina). Whipple Procedure.

  2. Columbia University Irving Medical Center. Columbia Surgery. What to expect from your surgery and hospital stay.

  3. Memorial Sloan Kettering Cancer Center. About your Whipple procedure. Updated November 28, 2018

  4. Pancreatic Cancer UK. Preparing for your pancreatic cancer surgery. Updated April, 2019.

  5. Cancer U K. Preparing for your pancreatic cancer surgery.  Updated April, 2019

  6. Truth Initiative. Why you should quit smoking before having surgery. Updated March 6, 2017.