Whipple procedure?

Gosh... and here I thought the Whipple Procedure had something to do with not squeezing the Charmin!

Pancreaticoduodenectomy
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Originally described by Alessandro Codivilla in 1898 and Kausch in 1912; and perfected by Allen Oldfather Whipple in the 1930s, pancreaticoduodenectomy is the operation of choice for the management of tumours of the head of the pancreas (the most common site of pancreatic cancer). The basic concept behind the pancreaticoduodenectomy is that the head of the pancreas and the duodenum share the same arterial blood supply, and these arteries run through the head of the pancreas, so that both organs must be removed. To remove only the head of the pancreas would compromise blood flow to the duodenum.

The most common technique of pancreaticoduodenectomy, commonly designated the Whipple (or Kausch-Whipple) procedure consists of the en bloc removal of the distal segment (antrum) of the stomach; the first and second portions of the duodenum; the head of the pancreas; the common bile duct; and the gallbladder.

It was named after American surgeon Dr. Allen Whipple who devised the procedure in 1935 and subsequently came up with multiple refinements to his technique (surgeons in training are often quizzed on the refinement he made that provided the most improvement in outcomes to that date: the use of non-absorbable silk over absorbable catgut suture). The first resection for a periampullary cancer was performed by the German surgeon Kausch in 1909.

The Whipple procedure today is very similar to Whipple's original procedure. It consists of removal of the distal half of the stomach (antrectomy), the gall bladder (cholecystectomy), the distal portion of the common bile duct (choledochectomy), the head of the pancreas, duodenum, proximal jejunum, and regional lymph nodes. Reconstruction consists of attaching the pancreas to the jejunum (pancreaticojejunostomy) and attaching the common bile duct to the jejunum (choledochojejunostomy) to allow digestive juices and bile to flow into the gastrointestinal tract and attaching the stomach to the jejunum (gastrojejunostomy) to allow food to pass through.

Originally performed in a two-step process, Whipple refined his technique in 1940 into a one-step operation. Using modern operating techniques, mortality from a Whipple procedure is around 5% nationwide (<2% in high volume academic centers).[1]

Some authors advocate the removal of the whole pancreas (total pancreatectomy) instead of just the head. However, clinical trials have failed to demonstrate significant survival benefits, mostly because patients who submit to this operation tend to develop a particularly virulent form of diabetes (so-called brittle diabetes).

More recently, the pylorus-sparing pancreaticoduodenectomy (a.k.a. Traverso-Longmire procedure) is growing increasingly popular, especially among European surgeons. The main advantage of this technique is that the pylorus, and thus normal gastric emptying, is preserved. However, some doubts remain on whether it is an adequate operation from an oncological point of view.

Another controversial point is whether patients benefit from retroperitoneal lymphadenectomy.

Pancreaticoduodenectomy is considered, by any standard, a major surgical procedure. In some hospitals, it carries a terrible reputation for high rates of morbidity and mortality. However, clinical trials demonstrate that it is a safe procedure in the hands of experienced surgeons in high-volume centres.


[edit] External links
Whipple Operation and Other Surgical Treatments for Pancreatic Diseases including Cancer
^ http://www.ddc.musc.edu/ddc_pub/patientInfo/surgeries/whipple.htm
Retrieved from "http://en.wikipedia.org/wiki/Pancreaticoduodenectomy"

Betsydoglover said:

Hi - lots more info on the Internet, where Bob found his.

I have a friend who's mother-in-law had pancreatic cancer and had this procedure. I am not at all sure whether or not there was a benefit as she had hideous problems healing from the surgery and only lived 6 or so months after the procedure. But all of her docs said it was the right thing to try.

Take care,
Betsy

HEY!! Are you accusing me of plague... plajer... Plagieris... copying that from the internet???

Would you believe I KNEW all of that and was merely reciting from my steel-trap brain?

yeah... me neither...

My 83 year old Dad recently "showed something" on his pancreas and the docs scheduled an endoscope to check it out. He was extremely healthy for his age (taking no meds) until he got a very weird bloodclot that ruptured below his knee, cut off the blood flow to his foot and he ended up having to have it amputated. It was during that time that the docs found the "spot". Two days before his procedure the surgeon called us and said if during the endoscope they found it to be cancerous the Whipple procedure would be the solution. BUT, given his age he doubted he would survive the surgery and it's tough recovery as Betsy mentioned. Age and health is huge with this very invasion and extensive surgery. My sister and I know a 50 year old man (an orthopedic surgeon) that exercised regularly that had it 18 months ago and is back at work and cancer free today.

Lisa P.

PS. My Dad got his "new leg" 3 weeks ago and we are now going for walks together outside to welcome in the Carolina spring. He loves "being tall" again and not being in his wheelchair.

Hi Ladybugg,
I have a friend here on the forums who I met in the Young Cancer survivors section. Her user name is Islet Cell. She had this Whipple procedure several years ago. Although she has had pancreatic cancer, she would probably be happy to answer your questions if you were to e-mail her via the forums here. I have not spoken to her in a while, but she is from B.C.
Take care,
Susan

scouty said:

My 83 year old Dad recently "showed something" on his pancreas and the docs scheduled an endoscope to check it out. He was extremely healthy for his age (taking no meds) until he got a very weird bloodclot that ruptured below his knee, cut off the blood flow to his foot and he ended up having to have it amputated. It was during that time that the docs found the "spot". Two days before his procedure the surgeon called us and said if during the endoscope they found it to be cancerous the Whipple procedure would be the solution. BUT, given his age he doubted he would survive the surgery and it's tough recovery as Betsy mentioned. Age and health is huge with this very invasion and extensive surgery. My sister and I know a 50 year old man (an orthopedic surgeon) that exercised regularly that had it 18 months ago and is back at work and cancer free today.

Lisa P.

PS. My Dad got his "new leg" 3 weeks ago and we are now going for walks together outside to welcome in the Carolina spring. He loves "being tall" again and not being in his wheelchair.

Hello,
My husband had a whipple at 34 years old 2 and a half years ago for duodenal cancer.
It is a huge op but appears to be the only cure for cancers in the area,if you are still after info there is a good chat room at DuodenalCancer@googlegroups.com that has a number of survivors who have recently had the op and also some that have been survivors for years
take care Belinda

shmurciakova said:

Hi Ladybugg,
I have a friend here on the forums who I met in the Young Cancer survivors section. Her user name is Islet Cell. She had this Whipple procedure several years ago. Although she has had pancreatic cancer, she would probably be happy to answer your questions if you were to e-mail her via the forums here. I have not spoken to her in a while, but she is from B.C.
Take care,
Susan

Hi my mom 63 years old had Whipple 2 1/2 years ago just found out on Friday cancer is back on her pancreas.She started chemo and will be getting another ct scan in 2 month but drs want to do surgery again, remove more of her pancreas. just wondering if any one has experienced this Thank you everyone

chriskeiski said:

I had this done in may of 2005, what do you want to know about it?

I had my whipple 5 weeks ago and home and doing well. I had an IPMN tumor which was removed and all signs are positive in terms of being cancer free. However, I am wondering about recovery: I have been going to work (as I own a small business) for the past few weeks ( about 4 to 5 hours a day). I am still taking oxy pain meds about 3 a day. However, just recently started to feel bad - tired, very sore, stiff, lazy. I was wondering how long you were on the pain meds?

PistilPete said:

I had my whipple 5 weeks ago and home and doing well. I had an IPMN tumor which was removed and all signs are positive in terms of being cancer free. However, I am wondering about recovery: I have been going to work (as I own a small business) for the past few weeks ( about 4 to 5 hours a day). I am still taking oxy pain meds about 3 a day. However, just recently started to feel bad - tired, very sore, stiff, lazy. I was wondering how long you were on the pain meds?

I had my surgery last April, I was home for 6 weeks...i had to have a wound vac becuase i developed some problems with my wound. anyway...i came home and managed to stop taking my pain meds within 4 weeks. even with the complications i worked with my home health nurse and we stopped it ASAP!