Whipple Procedure: Recovery

A Whipple procedure (pancreaticoduodenectomy) is a complex surgery involving several procedures during one operation. It is often performed to treat pancreatic cancer. It will take time for the digestive system to heal after this surgery on the pancreas, gallbladder, bile duct, stomach, and duodenum.

The average hospitalization time after a Whipple procedure is one to two weeks, with the initial night after surgery spent in the intensive care unit (ICU). Further recovery after discharge will take six to eight weeks.

Surgery Follow-Up

During the first eight weeks after discharge, you will be seen very regularly by your healthcare provider. Some surgeons schedule follow up postoperative exams every two weeks for the first two months, while others may want weekly appointments. The follow-up appointments commonly involve:

• Your incision site will be examined.
• Staples and tubes will be removed when the surgeon deems that it is time.
• Pathology and surgical reports will be reviewed.
• Diet and bowel function will be assessed.
• The effectiveness of pain management will be evaluated.
• Teaching on diet, wound care, activity after discharge and any other teaching necessary will be done.

Once the initial two month time period is over, after your Whipple procedure, your follow up appointments will be less frequent, such as every three to six months. During this time, your surgeon and healthcare team will:

• Order regular imaging tests such as magnetic resonance imaging (MRI) or computerized tomography (CT) scans to check for cancer recurrence
• Perform regular blood tests to evaluate for indicators such as tumor markers and to ensure lab values are within the normal range (such as liver function tests)

Most people who have a Whipple procedure because of cancer will need to go through a course of chemotherapy. But, this treatment does not usually start until approximately six to eight weeks after your surgery.

You will most likely be referred to a healthcare provider who specializes in treating pancreatic cancer; but, since your chemo treatment will be a course of treatment given over a specific time-span, you will need to be referred to an oncologist who is geographically close to your home.

Recovery Timeline

A Whipple procedure is a complex operation, it takes time for a full recovery; on average, a person may take around two months to fully recover from pancreatic surgery. Recovery from a Whipple procedure can be separated into various stages; each stage having a different set of goals and outcomes.

But, it’s important to keep in mind that each person recovers at a different rate, but there are some general aspects of a recovery timeline that apply to most people who have had a Whipple procedure, these include:

• First 4 to 6 hours: The average time it takes for your surgeon to complete a Whipple procedure.
• First 24 to 48 hours: The amount of time that most people spend in surgical intensive care unit before being moved to a surgical ward
• 3 to 10 days: The average time that a patient is in the hospital after pancreatic surgery
• 6 to 8 weeks: The time it takes to recover from the surgery

ICU

You can expect to awaken in the intensive care unit (ICU) (sometimes referred to as Post-Anesthesia Care Unit or PACU) with a nasogastric (NG) tube that has been placed through your nose and into your stomach to remove the normal contents of the stomach (such as saliva). This will help to reduce vomiting after surgery.

You will have a catheter in your bladder (a flexible tube that is placed through the urethra and into the bladder to drain urine out of the body and into a urine bag).

On the first day after your procedure, you will be expected to begin walking, gradually starting with shorter distances and building up each time you walk. Walking helps to speed recovery time, lowers the risk of pneumonia and decreases the chance of blood clots.

Surgical Ward

You will be closely monitored by various members of the healthcare team, including nurses, your surgeon, perhaps a dietitian to teach you about diet restrictions after surgery and more.

The first few days after surgery, you will not be allowed to eat any food (so that your digestive system can be allowed to heal after the procedure). Don’t expect to have a bowel movement for several days after the surgery.

IV fluid administration will be maintained for adequate hydration until your surgeon deems that you are taking oral fluids well and there is no longer a need for supplemental IV fluids.

You will initially be able to manage your pain via IV or epidural pain medications—usually a person is able to control the pain medication regime via a patient-controlled analgesia (PCA) device. Once you are able to eat solid food, oral (by mouth) medications will be given for pain. You will be discharged with a prescription for oral pain meds.

Discharge

Although most people are anxious to go home after any type of surgery, there are specific milestones that a person must overcome before being discharged once they have had Whipple surgery. You must:

• Be free of unresolved medical or surgical issues
• Exhibit a stable temperature and have no signs or symptoms of an infection
• Be able to walk without assistance
• Be able to tolerate food and liquids
• Be able to perform activities of daily living (ADLs) such as basic hygiene and self-care

In some instances (such as when a person is elderly) it is the recommendation of the healthcare team to discharge a person to a skilled nursing facility or rehabilitation unit before the patient goes home. A skilled nursing facility has professionals that can assist in recovering from a major operation such as a Whipple procedure.

The decision to discharge you to a skilled nursing facility may be made during your preoperative evaluation, but it is often addressed after surgery when the healthcare team can assess how ready you are to go home and evaluate other issues such as how much assistance you have at home and other healthcare issues.

After Discharge

Once you are released from the hospital, there are some strict instructions that your healthcare provider will give you to ensure that you continue the recovery process at home, these include:

• Do not remove your bandages for one to two weeks (and only after getting the OK from your healthcare team).
• Shower (do not bathe) with mild soap and water, gently wash around the incision area.
• Keep your incision covered and away from direct sunlight.

Don’t attempt to resume all of your normal activities right away; gradually work up to performing pre-surgery activities. Even if you engaged in a regular exercise/activity regime before your surgery, don’t assume you can just pick up where you left off.

You must start over, gradually working up to your normal routine, but only with the approval of your healthcare provider. Activity guidelines after Whipple surgery may include avoiding lifting anything more than a few pounds for at least six weeks (then get the OK from your surgeon before resuming normal lifting)

Other symptoms may include difficulty sleeping. This should begin to resolve as you recover. Talk to your healthcare provider if your insomnia does not begin to improve in time.

Wound Care

After your Whipple procedure, you will have staples or sutures (and you may also have Steri-strips, which are thin pieces of surgical tape) as well as a type of special dressing over your surgical incisions. You will most likely have a wound drainage tube (or more than one drainage tube) left in your abdomen as well.

Your healthcare team will keep an eye on your dressings on a regular basis and monitor your wound drainage tube to ensure your incision is healing well. You may go home with the drainage tubes still in place.

Upon discharge from the hospital, the nurse will give you specific instructions on how to care for your dressing and drainage tubes, which will most likely be removed during a postoperative, follow-up visit to your surgeon’s office.

Diet

The trauma of pancreatic surgery usually results in a condition called gastric ileus. This is a paralysis of the stomach (but it is only temporary) resulting in a lack of motility of the stomach. What this means is that food will not travel properly through the gastrointestinal tract. Due to postoperative gastric ileus, you will not be able to eat for many days after your surgery.

The Whipple procedure is the most common surgical procedure for pancreatic cancer, which has a major impact on digestion and nutrition status. The pancreas secretes insulin which helps to digest carbohydrates and enzymes that help break down fats, proteins, and carbohydrates.

There is no way to gauge exactly when a person will be able to eat after a Whipple procedure. The stomach will take time to regain its normal functioning. It may take a few weeks to a few months.

In the meantime, it’s a process of trial and error to discover how well you can tolerate food and liquids. But, even after you can hold down liquids and solid, easy-to-digest foods (such as gelatin or custard), it may be some time before you can eat a normal diet again.

Note In situations where gastric ileus does not go away after a Whipple procedure, a supplemental feeding tube and/or a special IV (called a PICC line) may be ordered to deliver adequate nutrients when a patient is unable to take in food by mouth.

Postoperative Dietary Guidelines

After pancreatic surgery, it’s common to experience many digestive problems, these may include:

• Diarrhea
• Nausea
• Gas
• Stomach pain
• Malabsorption of nutrients (apparent by the frequency and appearance of stools)
• Bulky, fatty, foul-smelling stools with an oily appearance
• Loss of weight
• Change in bowel habits
• Slow emptying of the stomach after eating
• Temporary symptoms of diabetes (could progress to permanent diabetes)

General Dietary Guidelines During Recovery

Although everyone is different regarding foods they can tolerate after a Whipple procedure, there are some general guidelines to follow, these include:

• Start with clear liquids, then progresses to full liquids (such as gelatin and custard) then soft solids.
• Eat small, frequent meals or snacks every three hours. Attempt to eat five to six meals or snacks with low fiber foods such as white toast, bananas, oatmeal, applesauce and baked potato (with no butter or other toppings).
• Avoid dairy products (except yogurt with probiotics).
• Eat protein foods first at each meal (to help restore lost muscle mass from the inability to eat after surgery).
• Drink fluids between meals to stay hydrated.
• Avoid fried, greasy and fatty foods that can be hard to digest. Select broiled or grilled foods instead. Your healthcare provider or dietitian may recommend limiting fat intake to no more than 40 to 60 grams per day.
• Try a variety of different foods to see what can be tolerated.
• Eat foods that are dense in nutrients (such as lean protein, whole grains, and fresh fruits and vegetables).
• Use food supplements (such as Ensure) if needed to get enough nutrients.
• Take pancreatic enzyme supplements with food, exactly as instructed by your healthcare provider.
• Consult with a dietitian for specific diet recommendations based on your level of food tolerance.

Coping

Coping with recovery from any type of cancer can be challenging, but those who have been through a Whipple procedure, followed by chemotherapy to treat pancreatic cancer, know, first hand, just what a real struggle it can be. The key, according to one man who has personally faced such a challenge, is to stay positive and don’t let it beat you.

“To everyone out there who has been diagnosed with whatever cancer, remember you are not alone. Remain positive and don’t let this terrible disease grind you down,” says Graham, age 49, who had a Whipple procedure in 2009.