Whipple procedure

The Whipple procedure, also called pancreaticoduodenectomy or pancreatoduodenectomy, is a type of pancreas removal surgery (partial pancreatectomy) used to treat pancreatic cancer and severe chronic pancreatitis (inflammation of the pancreas), as well as conditions in the first portion of the small intestine (duodenum) and bile duct. During the procedure, the head of the pancreas, gallbladder, bile duct, and duodenum are removed. Part of the stomach may or may not also be removed during Whipple surgery. When the stomach can be kept intact, the treatment is called pylorus-preserving Whipple procedure. Penn Medicine surgeons will try to perform a pylorus-preserving Whipple procedure as often as possible, when appropriate.

Although a Whipple procedure can have potentially lifesaving benefits, it’s a complex operation that should be performed by experienced surgeons. As experts in pancreatic surgical and cancer care, Penn Medicine’s surgeons perform over one hundred Whipple procedures each year and are national and international leaders in their field.

Robotic, minimally invasive Whipple procedure

Penn Medicine specialists perform minimally invasive, laparoscopic surgery using robotic tools for many types of surgery, including the Whipple procedure. Instead of a larger abdominal incision, a surgeon operates through several small incisions and uses robotic arms to make precise movements. Due to the complexity of the Whipple procedure, the minimally invasive robotic technique can result in greater accuracy and a quicker recovery. Your doctor will determine if the robotic method is appropriate for your case.

Based on your diagnosis, health history, and other factors, your care team will help determine if the Whipple procedure is right for you. For some types of pancreatic cancer, pancreas removal surgery, like the Whipple procedure, may stop it from spreading and improve your chances for a healthy life.

When used as a cancer treatment, the Whipple procedure is usually recommended for patients whose cancer is confined to the head of the pancreas and has not spread to nearby tissues or distant organs.

Conditions treated by the Whipple procedure

The Whipple procedure is most often used as a treatment for pancreatic cancer located on the head of the pancreas. It can also be used as a surgical treatment for other conditions such as:

• Benign pancreatic tumors and cysts (like IPMN)
• Severe chronic pancreatitis 
• Ampullary cancer
• Bile duct cancer
• Conditions affecting the duodenum (including cancer)
• Neuroendocrine tumors (both functional and non-functional)
• Gastrointestinal Stromal tumors (GISTs)

The Whipple procedure can be done either through open surgery or through minimally invasive surgery using laparoscopic or robotic techniques. Your doctor will help you decide which type of Whipple surgery is best suited for you. They will also thoroughly explain the Whipple procedure steps and how to prepare for your procedure, including fasting and temporarily stopping certain medications.

You will be placed under anesthesia to ensure you don’t feel any pain during the operation. Your surgeon will start by making an incision in your abdomen, if performing an open surgery technique, or several small incisions, if the procedure is performed as minimally invasive surgery. They will check your lymph nodes and organs and take tissue samples for a biopsy to be reviewed by a dedicated pancreatic pathologist. Next, the surgeon will then remove the tumor/disease process, the head of the pancreas, duodenum, gallbladder, bile duct, and sometimes part of the stomach, if necessary. The surgeon will reconnect the remaining pancreas, stomach, and bile duct to the small intestine to ensure you can digest food normally thereafter. Your incisions will then be closed, and you will be sent to a recovery area to be monitored as you recover from anesthesia.

The procedure can take between five to eight hours.

The Whipple procedure is a highly complex surgical technique that may require a longer recovery time than other types of pancreas removal or gastrointestinal surgery. Following the operation, you may spend up to a week in the hospital to ensure there are no complications and that your incisions have healed properly, and that you are able to tolerate food.

It generally takes about four to six weeks to fully resume everyday activities, but each person’s recovery timeline is different. Your doctor will be able to guide you on your specific recovery timeline.

Like all types of surgery, the Whipple procedure comes with a certain amount of risk, such as bleeding and infection or poor wound healing. These risks are rare, but the removal of the pancreas and other major organs can result in:

• Runny bowel movements 
• Diabetes (short-term and/or long-term)
• Difficulty emptying the stomach or keeping food down
• Leakage from the bile duct and/or the pancreas connection
• Blood clots and/or embolisms

Your care team will help you navigate these post-surgical challenges and provide expert, compassionate relief for your symptoms.

Whipple procedure at Penn Medicine

Penn Medicine’s surgeons are among the most experienced in all types of pancreas removal surgery, including the Whipple procedure. We offer the latest and most advanced minimally invasive methods, like robotic and laparoscopic techniques, when appropriate. Whenever possible, our surgeons try to perform the pylorus-preserving method, which prioritizes saving the stomach.

As part of our pancreatic care experience, our patients receive well-rounded care from renowned medical oncologists, experienced surgeons, and a team of related specialists to ensure all aspects of your condition receive the best possible care. We are among the lowest in the nation for post-surgical complications and offer some of the fastest recovery times.