By: GARGI PINGALE and SAHANA KOUNDINYA Whipple Procedure By: GARGI PINGALE and SAHANA KOUNDINYA

What is it? Laymen term for “Pancreatoduodenectomy” Complex operation to remove part of the pancreas, small intestine or part of gallbladder It is used to treat pancreatic cancer that’s isolated to the head of the pancreas But it can also be used to treat other tumors/abnormalities in the head of the pancreas, small intestine, and bile duct

Pancreatic Cancer Caused by damage in DNA (mutation) Cancer begins in cells that line the ducts of the pancreas Rarely, cancer can occur in the hormone-producing cells of the pancreas Common in: African Americans Overweight people Diabetics Smokers Genetics Can cause: Jaundice - blocks liver’s bile duct Bowel Obstruction - tumor presses on the duodenum and blocks flow of digestion Pancreatic Duct Head Neck Body Tail

Why the Whipple Procedure Works The surgeon removes the head of the pancreas, gall bladder, part of the duodenum (uppermost portion of the small intestine) and lymph nodes. The surgeon then reconnects the remaining pancreas and digestive organs This helps because now the pancreatic digestive enzymes, bile and stomach contents will flow into the small intestine during digestion as they normally should

Stomach Liver Common Bile Duct Pancreas Gall Bladder Duodenum Jejunum Pancreatic Duct Jejunum

What Happens During a Whipple Procedure? The surgeon will make a small incision in the abdomen to insert a laparoscope--a thin, lighted tube with a tiny camera that allows the surgeons to look at your abdominal cavity and internal organs This allows doctors to evaluate any potential spread of disease that may not have been visible on the CAT scan If no disease is seen outside of the pancreas, the surgeon will remove your tumor and reconstruct your GI tract. The surgery usually takes approximately four to eight hours to complete Many people will recover entirely in two months Post-Procedure Esophagus Gall Bladder Bile Duct Stomach Small Intestine

Risks with Procedure Part 1 One third of people have some sort of complication with this surgery which include Bleeding Infection Clots Pneumonia Heart attack The most common complication is delayed gastric emptying, a condition in which the stomach takes too long to empty its contents. If condition persists, supplemental feedings by tube are necessary Usually lasts for another 7-10 days 5 year survival rate of 20%

Risks with Procedure Part 2 The most serious potential complication is abdominal infection due to leaking where the pancreas has been connected to the duodenum. occurs in 10% of patients usually managed by a combination of draining tubes, antibiotics and supplemental feeding The only possible long term effect is digestive difficulties The surgery also lasts 5-8 hours so there is obviously a chance that the patient will have complications present with any general surgery (not waking up from anesthesia)

References http://www.webmd.com/cancer/pancreatic-cancer/whipple-procedure?page=2 http://www.mayoclinic.org/tests-procedures/whipple- procedure/basics/definition/prc-20021393 http://www.webmd.com/cancer/pancreatic-cancer/whipple-procedure http://www.uchospitals.edu/specialties/cancer/pancreatic/surgical/whipple.html #P15_1117