Pancreatoduodenectomy (Whipple s Procedure) Your doctor has arranged to surgically remove part of your pancreas or Whipple s procedure. We have written this pamphlet to help you learn about your surgery and how to care safely for yourself at home. How Does the Pancreas Work? The pancreas is a pistol shaped gland. It lies behind the stomach. Glands in the pancreas make enzymes that are needed to digest the fats, proteins, and sugars we eat. A duct (tube) that runs the length of the gland carries the enzymes to the duodenum (the beginning of the small bowel). The islets of the pancreas secrete insulin and glucagon into the bloodstream. They control your blood sugar level. Lack of insulin causes diabetes.
What is a Whipple Procedure? In the Whipple s surgery, a part of the pancreas, a portion of the bile duct, the gallbladder and the duodenum (beginning of small bowel) are removed, sometimes with part of the stomach. After removal of these structures, the remaining pancreas, bile duct and stomach are connected to the small bowel. This allows pancreatic enzymes, bile and food to flow back into the bowel. Digestion can then proceed normally. The operation usually takes 4-7 hours. Why is a Whipple Procedure Done? A Whipple s operation is usually performed for cancers of the head of the pancreas. The operation is also used to treat cancers of the bile ducts, duodenum, or adjoining structures. It may also be done for benign (noncancerous) disorders of these organs, such as pancreatitis. The exact problem in your case may or may not be known before the operation. Your surgeon will discuss the operation and why it is needed with you. Before Your Operation Blood work and other tests are often needed before this surgery. You may need to be admitted to the hospital a few days to a week before surgery for these tests. Please read Same Day Surgery Admission to learn what will happen during this time. After Your Operation You will be taken to a special recovery area. Your breathing, pulse and blood pressure will be checked often. Some patients may need to be cared for in the Intensive Care Unit and/or Intermediate Care Unit for a period of time. When you are stable, you will be taken to the General Surgery Unit. What to Expect After Surgery Intravenous You will have a small plastic tube (intravenous or IV) in your arm while you are not able to eat or drink. This will give you liquid, salts and some sugar. The doctor may insert a special intravenous line called a central line into your neck or upper chest. The central line is used to give fluids, medications and nourishment. 2
Oxygen You will have oxygen running during the first night after surgery, and for longer if needed. The oxygen is often given through two small tubes under your nose. Bladder Catheter You may need a tube in your bladder to drain your urine because of the type of surgery you had or the medications you are being given. It will be taken out as soon as possible. Discomfort/Pain There will be some discomfort around your incision and abdomen. The pain can be relieved by medication. The anesthetist (doctor who will put you to sleep for the surgery) may wish to control your pain by giving the medication continuously through a small tube inserted in your back. It is called an epidural and will remain in place for 3-4 days. Nasogastric Tube (nose to stomach tube) You will only have sips of water for the first 3-4 days. During this time, you will have a tube that passes through your nose, with the tube tip sitting in your stomach. It will be attached to a small suction machine at your bedside or on the wall. The tube will keep your stomach empty and helps to prevent nausea. The nurse will give you swabs to moisten your mouth. After the tube is removed, you may start to take a full liquid diet. Nutrition When you are ready, your doctor will first order a full liquid diet (milk, cream soups, puddings, porridge, ice cream, tea, coffee). If this is tolerated, you will be advanced to a soft, low fibre diet. You will not receive foods that may cause discomfort and gas (no raw fruit or vegetables, no whole wheat bread, no spicy food). If you have other food intolerances (such as lactose intolerance), please tell your nurse or the diet technician who can assist you with your menu selection. She may also ask you if you would like to receive snacks or nutritional supplements (such as Ensure). These will help to nourish you after surgery, if you feel you are ready for them. If your nasogastric tube has to stay in place for a longer period of time, you may receive nutrition by continuous intravenous called TPN, or from a tube placed in your bowel, which would allow you to receive tube feeds. Drainage Tube from Abdomen You may have a drain near your incision to drain fluid from your abdomen. It will be removed when there is very little drainage (about 4-5 days after surgery). 3
Activity Moving your legs and wiggling your toes often improves blood flow. This helps prevent blood clots from forming in the veins of your legs. Your nurse or physiotherapist will help you out of bed. You will gradually increase your activity. Although you may have discomfort, it is important to get up and move around. To prevent pneumonia, you will be asked to do deep breathing and leg exercises every 1-2 hours. Going Home When your doctor feels that everything is healing well and that you are strong enough, he/she will help you prepare for discharge. This is usually 7-14 days after surgery. You may feel a little anxious about going home, but remember to take it slow and be sure to get lots of rest. At Home Controlling Pain or Soreness You may take pills for pain or soreness at home for a short period of time. Take the pills as instructed. Watch out for constipation. Do not drink alcohol while you are taking pain pills. Activity After your surgery and for several weeks, you will find that you will tire easily and may need extra rest. Gradually your energy will return. Some examples of good activities for you are: light housework, preparing small meals and riding as a passenger in a car for a short distance. Walking is the best thing for you after your surgery. Start slowly and increase the distance each day. For the next 6 weeks avoid: - Moving furniture, mowing the lawn, shoveling snow, lifting heavy objects. - Long car trips - if a long car trip is needed, have someone else drive. - Strenuous exercise. 4
Resume sexual activity when you feel well enough. When comfortable enough, you may resume driving a car. Do not drive if you are taking pain pills. Meals and Snacks It may take a while for your appetite to return to normal. During this time, it may help to eat smaller meals more often. Try to eat three small meals and three snacks daily. Healthy meals will help your body heal. Be sure to get a source of protein at each meal and snack. Protein comes from meat, fish, poultry, eggs, and all dairy products such as milk, cheese, yogurt and cottage cheese. You may have trouble digesting fat after your surgery. Signs of fat indigestion or malabsorption are cramping and/or loose pale-coloured floating stools. Avoid greasy and high fat foods such as deep-fried foods. Choose low fat dairy products (such as 1% milk, light cheese, low-fat cottage cheese), lean meats, and remove the skin from poultry. If you are having trouble digesting fat, call your doctor. Your doctor may need to prescribe pancreatic enzymes for you to take with meals. If you are losing weight (more than 2 pounds per week for more than 2 weeks) and your appetite has not returned, try drinking nutritional supplements (such as Ensure, Boost, or Carnation Instant Breakfast ) with a meal or as a snack. You may have a short term problem with nausea, vomiting, and/or loss of appetite for about 2-6 weeks after surgery. As much as possible, try to follow the diet guidelines we have suggested. Care of Your Incision If your drains have been removed, you may take a shower. Pat your incision lightly to wash and dry. There should not be any drainage or increased redness from the area. You may have a bath when the incision is healed, in about 10 days. If your staples (metal clips) have not been removed before you leave the hospital, you will be given an appointment with your surgeon or family doctor to remove the staples 7-10 days after surgery. 5
Follow-up Care If you are from mainland Nova Scotia, a visit will be booked with your surgeon a few weeks after you go home. It is very important that you keep this appointment. If you are from Cape Breton, or from out of province, you may see your family doctor for follow-up. You will be given a letter for your family doctor. Returning to Work Your general health, recovery and type of work will determine when you can return to work. This needs to be discussed with your doctor. Call your doctor if you have: Fever and chills. Nausea and vomiting. Increased redness, swelling, or warmth around the incision. Increased pain or tenderness around the incision. Separation of the edges of the incision. Drainage from the incision. More questions? Do not hesitate to ask any questions. We are here to help. Looking for more health information? Contact your local public library for books, videos, magazine articles and online health information. For a list of public libraries in Nova Scotia go to HTTP://publiclibraries.ns.ca Capital Health promotes a smoke-free and scent-free environment. Please do not use perfumed products. Thank you! Capital Health, Nova Scotia www.cdha.nshealth.ca Prepared by: Eleanor Griffiths RN, BScN, CNE, QEII, Halifax Approved by: Brock Vair MD, FRCPC Illustration by: Page 1-Parlay International 1980; Pages 3, 6 & 9-LifeART Health Care 1 Images, Copyright 1994, TechPool Studios Corp. USA Designed and Printed by: QEII Audio Visual and Printing Departments WI85-0596 Created July 2007 The information in this pamphlet is to be updated every 3 years. 6