Whipples Operation

This operation is done for a variety of malignant and benign diseases of the pancreas and nearby organs. It is commonly performed for cancer of the head of the pancreas, the ampulla, the distal common bile duct, and the duodenum.

The procedure can also be done for some uncommon procedures affecting the head of the pancreas, as well as for some special cases of pancreatitis. Tumour of the head of the pancreas and distal common bile duct can block the flow of pancreatic fluid and bile, causing jaundice, a yellow discolouration of the skin and eyes.

The Whipple’s procedure is done to remove the diseased area and to reconnect the gastrointestinal tract so that you can eat, drink and digest food normally.

The Whipple’s operation includes removing the distal common bile duct, including the gallbladder, the head of the pancreas and the duodenum. It may also be necessary to remove the lower part of the stomach and its connection to the duodenum if the disease process involves this area. The operation takes 4-5 hours. At the completion of the operation the remaining pancreas, bile duct, and stomach have been rejoined onto the small intestine.

After Surgery

After surgery you may be taken to the Intensive Care Unit for close observation for about 24 hours. It is usually possible to return to your normal ward the next day. You will have a number of tubes into your body. One tube passes in through the nose and down through the stomach to keep the stomach empty and prevent nausea and vomiting. There will be three tubes passing into the abdomen. Two of these are drain-tubes and allow fluid that would otherwise collect in the area where the pancreas used to be to be drained away. The third tube passes directly into the bowel to allow feeding directly into the intestine, should there be slow recovery of the stomach, bile ducts or pancreas after the surgery. You will have an IV tube in your vein to give you fluids, and you may have more than one of these. There will be a tube placed to allow urine to drain until you are well enough to do this for yourself.

The day after surgery you will be assisted out of bed by the nursing staff. You may sit in the chair for a short time and walk a short distance. To help in your recovery your nurse or physiotherapist will ask you to do deep breathing and coughing exercises. Pain medication will be available to help you with any discomfort. Make sure you let your nurse know if your pain medication is not working. It is important for your recovery to use the pain medication, to assist you in getting out of bed and doing breathing exercises.

Your activity will progress each day until you are walking by yourself. Walking is strongly encouraged to increase your strength, to prevent breathing problems, and to help the return of normal bowel activity.

You will only be allowed small amounts of ice to suck until healing has occurred along all of the inside suture lines and the bowel is working normally again. You will then be allowed to drink small amounts of liquid and your diet will be increased each day.

All tubes will be removed prior to you leaving hospital, except the feeding tube if this has been placed into the bowel. This must remain in place for 4 weeks. When you are discharged from hospital this will be placed under a simple dressing so that you can shower and resume all normal activities. It will be removed in Mr Evans’ rooms. This is usually performed at the first post-operative visit. You should take two analgesic tablets 1 hour before your appointment time and allow some time to lie down in the consulting rooms after the tube has been removed.

Discharge Instructions

Diet

You may resume the same diet you were on prior to surgery. If your diet needs to be adjusted after surgery a dietician will visit and explain your special diet changes.

Medications

Most patients require no specific medications after their surgery. Some patients do require medications to replace the functions of the pancreas. This may be temporary or permanent. These medications will be in the form on insulin or enzymes. Your nurse will instruct you in the proper administration and use of any medications that you will require.

Pain Control

You will be given a prescription for pain medication, which should be taken as prescribed.

Activity

You may resume light activities at the time of discharge. You may walk up stairs and ride in a car. You should not drive a car until you have completed taking all pain medications and are moving around comfortably. This usually requires 10-14 days after discharge. You should not lift anything heavier than 10kgs for the first six weeks after your operation.

Bathing and Showering

You may shower at the time of discharge but will be instructed on how to keep the feeding tube covered during this. You should not bathe until the feeding tube has been removed and its small wound has healed.

Wound Care

A dissolving stitch, which remains in place for about 2 months, will be used to close your wound. Small white strips will be placed over this, called Steri-strips, and should be removed 7 days after discharge. It is not usually necessary to have any dressing on after this time.

Signs of Infection

• Temperature higher than 38 °
  
  
• Swelling, tenderness, redness, or opening of your suture line or any unusual drainage from your suture line or wound drain sites
  
  
• Nausea, vomiting, or shaking chills

When to Call a Doctor

Contact these rooms if you develop any signs of infection, if your skin or eyes become yellow, if you have pain that is not controlled by your pain medication, or if you have any other concerns. Please try to contact Mr Evans in the first instance, rather than your local doctor.