The Whipple Procedure | Johns Hopkins Medicine


[MUSIC] The pancreas is an organ that resides deep
in the abdomen. It rests against the backbone in front of
two major blood vessels called the aorta and the
inferior vena cava. It is also covered by the stomach and the
liver. The pancreas is divided into three anatomical portions, the head, body, and
tail. The head of the pancreas is surrounded by
the duodenum the part of the intestine that connects the
stomach to the small bowel. The tail of the pancreas resides in the
hylum of the spleen. The pancreas has two very important
functions most of the gland is involved in producing the digestive enzymes that are collected in
the main pancreatic duct, and then emptied into the
duodenum. These enzymes are involved in the
digestion of fats, sugars and proteins. There are also small microscopic groups of
cells dispersed throughout the pancreas, called
the Islets of Langerhans. These small groups of cells produce a
variety of hormones, including insulin, that are released
directly into the blood and help regulate a variety of different functions,
the most important of which is keeping the blood sugar, or glucose, in
a normal range. Glucose is the main source of energy for
the body. A variety of benign and malignant tumors
can arise in the pancreas, often in the head of the
gland. Tumors in this area present a particular problem because the head of the pancreas
is at an important crossroads where the
pancreatic duct empties its digestive enzymes into
the duodenum. And the bile duct delivers bile from the
liver and gall bladder. If a malignant tumor such as a pancreatic
cancer arises in the head of the pancreas, it will often block both the
pancreatic duct and bile duct. Resulting in a patient turning yellow, or
becoming jaundiced. When the bile duct is obstructed by a tumor, bilirubin, a yellow substance
produced in the liver, is no longer able to empty
into the duodenum and be excreted. And backs up in the blood, and the patient
turns yellow. This is often first noticed in the whites
of the patient’s eyes. Yellow jaundice is often the first clue
that the patient has a pancreatic tumor. Weight loss and abdominal pain may also be
symptoms of a pancreatic tumor. When these symptoms are present, the
physician will order a cat scan to look for a tumor or other
important signs. Such as a dilated bile duct in the liver
or a dilated pancreatic duct, both of which can be caused by tumor
obstructing the ducts. If cancer is diagnosed, the physician will
use the CAT scan and possibly a variety of other tests to
stage the cancer. And determine whether the tumor has spread
beyond the pancreas. If it has not the cancer’s considered
resectable and the patient is a candidate for an operation called the Whipple
operation or a pancreaticoduodenectomy. The whipple procedure or
pancreaticoduodenectomy is a major operation that often takes between five
and six hours. The patient is admitted to the hospital,
prepared for surgery and then put to sleep with general
anesthesia. After the patient’s abdomen is prepped
with an antiseptic, and draped appropriately, generally the operation is
performed through a midline incision. Under certain circumstances the operation
can also now be done laprascopically through four or
five small incisions. However, most operations are still done
through an open incision. Once the incision is made, the surgeon
carefully explores the abdomen to confirm that the tumor has not spread beyond the
pancreas and its surrounding area. And therefore can still be surgically
removed. Because the head of the pancreas is
located so deep within the abdomen. Many structures have to be divided before
the tumor can be removed. The gall bladder is mobilized and the bile
duct leading to the duodenum is divided. Next, the duodenum is divided to preserve
the entire stomach as well as the Pyloris valve in the first
portion of the duodenum. This is referred to a pylorus-preserving
Whipple procedure. In some cases, the surgeon may perform a
classic Whipple procedure where a portion of the stomach
is also removed. The neck of the pancreas is divided being
certain that no tumor is left behind in the neck or body
of the gland. One of the most important steps in this operation involves removing the
pancreas and tumor from two important vessels that supply
blood to the intestines and return it to the liver. These are called the Superior Mesenteric
artery and the Superior Mesenteric and Portal
veins. Occasionally if these structures are
involved with tumor, portions of these important veins are also
removed. This dissection is quite complicated and
prolongs the operation. The proximal small bowel, called the
jejunum is divided allowing the entire specimen to be mobilized and
removed from the body. Once the specimen consisting of the
pancreas containing the tumor. And the surrounding tissues is removed,
the reconstruction is then carried out in a step wise
fashion. Generally, the remaining pancreas is
reconnected or anastomosed to the proximal small bowel in an end to side
fashion. Next, several inches beyond the first
anastamosis, the bile duct is reconnected to the
jejunum. Finally downstream from the bile duct
anastamosis, either the duodenum or stomach is
reattached to the jejunum depending upon whether a
pylorus preserving or a classic Whipple has been
performed. So in summary, a Whipple operation, or
pancreaticoduodenectomy, removes a portion of the pancreas containing the
tumor, the gallbladder and distal bile duct, and most
of the duodenum along with a section of small
bowel or jejunum. The reconstruction includes a nastimosine
or reattaching the pancreas, the bowel duct and duodenum, or stomach,
to the small bowel or jejunum. Patients undergoing this extensive
operation are often placed in an intensive care unit for observation for the first 24
hours after surgery. The next day following surgery the patient
is gotten out of bed. Often ambulated in the nasogastric tube
that is placed through the nose down into the stomach during the
operation is removed. Many patients will start taking sips of
water during the first post-operative day, and usually will be discharged from the
intensive care unit and go to a floor. The second day after surgery, patients
often start taking liquids. And as early as the third post-operative
day, may actually begin on solid foods. Drains are frequently left in place after
the operation, to collect any secretions that may be
present after surgery. If appropriate, the two drains are removed on the fourth and fifth post-operative
days. If a patient has done well with no post-operative complications, they may
leave the hospital as early as the sixth or the seventh day, but a hospitalization of about eight days is
the average. After a recovery period of several weeks,
the vast majority of patients will be able to resume a
normal life. Depending upon the type of tumor and lymph
node involvement, chemotherapy or radiotherapy or both, maybe indicated
starting six or eight weeks after surgery. [MUSIC]

100 thoughts on “The Whipple Procedure | Johns Hopkins Medicine

  1. I have a realistic attitude a Whipple surgery cost around 80.000 dollars I know because my wife had one , in the end she spent three months in a coma for a cancer that did not exist .
     That is why when we wrote our first book it was  titled {Nightmare at saint Francis} we were told it would never be published at least not without changing the names of the doctors and hospital .
     Guess what it is now available at amazon books along with hundred or thousands of other places.
     With over 800.000 in med. bills after three months of living  in one emergency room after another   I have a real good idea of how some doctors and hospitals work   

  2. I had a Whipple 3 years ago now. I am surely grateful to God and the surgeons who performed my surgery. EACH, Ft Bliss TX, February 2011…God bless you all!

  3. My mother had this done last year at 82 years of age. Her surgery lasted 11 hours. What they didn't mention was that many have a feeding tube. Hers was a J-tube. Sadly she passed away the end of This Feb. 

  4. Back in the early 90's Santa Claus was my patient coming back from surgery that had a Whipple.  Surgery called up and said he was not doing well and transferred him to the SICU with a palpable blood pressure. That code did not go well and Santa Claus saw Jesus that morning. Hospital policy changed that month in stabilize before you transfer.

  5. It is here. I have my biggest struggle. Mentally but more physical. I have to have this done. Trying to shrink it with chemo…2nd time around. I get tired alot and understand the chemo effects differenty each time. I am trying to find the words to say to all that shared your thoughts all of you. 

  6. Don't get me wrong, but shouldn't the reconstruction be carried out as to mimic and or duplicate what was taken out? Attaching the Jejunum directly end to end at the Pylorus valve then attaching the bile duct from the Liver and then finally the Pancreas. I see complications with foods getting stuck above the Jejunum at the Pancreas. Or am I the only one seeing improper flow of bile and food?

  7. I'm pretty glad to live in the 21st century that we have good medicine but it seems that a lot of this stuff is just advanced butchery, when can we gain the knowledge to talk to cells directly and tell them to stop being nuisances?
    It's just a signalling molecule somewhere, right?

  8. This is the voice of professor john cameron the king of Whipple procedure,he did 1000 procedure during his career

  9. You know nothing Johns Hopkins… Removing anything is not going to prevent anyone from taking care of themselves.. and thusly all dis- ease will continue.

  10. I have a question in regards to this surgery.

    My grandfather is 90 and has this type of cancer, the doctor suggested it's too risky for someone his age, and therefore we are not treating the condition out of my grandfathers wishes.

    Normally what is the average lifespan of someone whom is left untreated?

  11. last year Oct. 2014 I was diagnosed with pancreatic head mass & had a Whipple's procedure in SPMC Davao City Philippines. they took me from my room at 6am & I returned 11pm. I am grateful to God he gave me a second chance of life. & to the surgeons who did my procedure ur so great. job well done doc..

  12. Good afternoon, my name is Elsa Escobar. I have 27 years old.
    I had whipple surgery in september 2013 and i could not even do me no control, my question is.
    What would the exams i should like to make me a good control?
    thanks

  13. I am a Whipple survivor, had mine at Uni MD med center 2 June 2015. They performed the modified Whipple, where I kept all of my stomach and the pylorus valve. The point they make about jaundice being the first indicator is true, that's what led to my diagnosis of a tumor (Stage 1) in the head of the pancreas. It was found early enough that I qualified for surgery without needing chemo and/or radiation beforehand. There was no involvement of any other organs or blood vessels, though it had grown to Stage 2 in the 3 weeks between diagnosis and surgery. I dodged a huge bullet. My uncle died of PC in June 2008 (diagnosed at late Stage 4), have a 1st cousin from that side who is now a PC patient (Stage 3)…genetic testing showed I have a slightly elevated chance.

    If you feel something is off, get to the doctor. I did, that's why I'm alive.

  14. Hi there. My mom is having this surgery in a week. She has a neuroendocrine tumour on the head of her pancreas. She's 55 and healthy. She, along with myself, are both very worried about this. I just wanted to know if anyone out there has had this surgery and have any words of advice in regard to procedure, recovery etc. Thanks

  15. I have some positive symptoms, not including jaundice just a lot digestion problems, negative CT and good blood work I'm wondering if they should be looking at some other disease or–if it's just taking its time to rear its ugly head

  16. My partner went through this procedure 10 months ago, he was opened up twice, got Klebsiela Pneumonia and a Klebsiela Bed Sore (you can only get Klebsiela from the equipment used for the operation or in the hospital). Spent 7 or 8 days on a respirator, ended up with G and J tubes, and had his incision from side to side just below his rib cage, not up and down. A wound vac used on his incision and after that healed enough, on his bed sore, think he had the vac on one or the other for around 4 months He's only in his 50s, spent 2 months in the hospital and after 10 months, we still have home healthcare coming out because his incision has never fully healed. Never had cancer, but had calcification blocking the head of the pancreas. Caused from Pancreatitis, that he was told over and over again that he didn't have. He isn't or never was a drinker. This video makes the operation sound like a Walk In The Park, they just forgot to tell you that there is a mugger behind every bush! I have also found, to many people that have had my experience themselves or worse. My thoughts are with any person having to deal with this in anyway!

  17. If you have cholangiocarcinoma (bile duct cancer), go on this trial:
    http://cholangiocarcinoma.org/immunotherapy-of-cholangiocarcinoma/

    This
    immunotherapy is working. My brother is taking this oral pill (V3-X).
    If you live in the states, it's $1500/month. If you live in Mongolia,
    you can do the trial for free.

    If you look at
    www.clinicaltrials.gov, search under the company name: Immunitor, Trial
    country: Mongolia Disease: cholangiocarcinoma (bile duct cancer).

    There is also a drug coming down the pipeline for pancreatic cancer. Check out Immunitor.

    Also,
    if you have a liver metastasis, Immunitor has a drug called V-5 that is
    in its third phase trial. It is also listed under
    www.clinicaltrials.gov. Youtube also has a retired dentist who uses V-5
    and survived stage IV liver cancer.

    Please start looking at trial drugs if you have cholangiocarcinoma (bile duct cancer), liver or pancreatic!!!!

  18. thanks for the vid mate. got my whipple in a few weeks. 36 yr old, feel fine, had 12 doses of chemo easy (5 hours on drip in chemo ward then 2 days home with chemo cd case attached ) once i got used to nosebleeds etc

    cant wait … they did mention something about a lazer pen !!! my doc seemed sooo excited talking about it. but what i got from the convo was it was still experimental and if they go into me and find its got close to that pesky blood veins again then then he may be able to have a play with his new toy, if not then its this whipple .. i thought i was out of action 6 months not 6 weeks so thanks again 🙂

    much love , uk

  19. Steven of Anita and Steven here, yet another screen name.

    As of right now I am 33 months and 4 days post-Whipple and have had no recurrence.

  20. I’m a survivor of duodenal cancer – I had the Whipples procedure In Adelaide South Australia. There were complications, I went to surgery 3 times in one week, for bleeding. I was in hospital for 6 weeks. That was in 2012. I’m still cancer free, even though I was misdiagnosed for 9 months, initially. I had no chemo or radiotherapy. I’m a walking miracle because 22 lymph nodes surrounded the tumour and not one had cancer.6 years on, I’m living a normal life, eating a balanced, normal diet. Thank You God. 🙏

  21. In listening to and watching this description, I'm brought back many years to the first Whipple procedure that I ever saw. It was performed in Phila. but a great professor of surgery. He was a renaissance man in many ways and both meticulous and supremely skillful. I have never known or seen his technical better. That patient did well, was followed for years and seemed to have been cured.

  22. 06:13 isn't the proximal small bowel considered the duodenum and the distal part the jejunum+ileum? I suppose its different anatomical terminology.
    The video in its whole is a delightful opportunity for health professionals and students to examine their knowledge.
    Thank you very much @Johns Hopkins Medicine!

  23. Lost both my mum 2001 and dad 2013 from stage 4 Pancreatic Cancer, blessings to all who were able to benefit from this procedure, I've read a lot of material on the subject, it's definitely an organ with a total mind of it's own. Eat clean healthy foods, avoid processed and high sugary foods, and little Alcohol, papaya is extremely good as it contains an enzyme that can penetrate through and help it work well. Great video.

  24. I’m here because Dr. Webber just stole Dr. Bailey’s Whipple. And they were planning on doing it with on doing it laparoscopically, meanwhile the hardest part Dr. Webber is going to let Dr. Meridith Grey do 🙊

  25. Back in 1986, They opened up my dad and told us it was too late. They could not go further. Any thoughts or experiences?

  26. Greeting to you all,
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  27. I'm now celebrating 8 years of survival after the Whipple Procedure performed by Dr. Ryan Holbrook, Spokane, WA, and I had a party to celebrate! I feel blessed. I had a great primary care doc, Dr. Jerry Lochner and a great surgeon plus so much support from friends and family. I did have chemo and radiation, which I said I would never do.

  28. If there is no cancer involved with the Gallbladder and it also produces enzymes required to digest certain foods WHY REMOVE IT? If you ask me this so called "The Whipple Procedure" is a hold over from the 1800's!

  29. As a comment thread I started took up a lot of space…

    Ladies and Gentlemen, Steven of "SPSR1957" and "Anita and Steven" is indeed still alive and doing pretty well.

  30. My dad has been diagnosed with pancreatic cancer about four months ago. 😢😔 They already did four sessions of chemo but it didn’t work. Now they want to look for other options. The tumor has spread to the important arteries nearby! Is this a operation that my dad can have?????

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