Our Summary

Pancreaticoduodenectomy, often referred to as the Whipple procedure, is a complex surgical operation to remove the head of the pancreas. After this surgery, a common complication is the formation of a pancreatic fistula - an abnormal connection between the pancreas and other organs. Predicting the occurrence of pancreatic fistulas is a significant challenge in this field of surgery. This paper discusses various scoring systems that have been developed to help predict the risk of these complications. These include the Fistula Risk Score (FRS), adjusted-FRS (a-FRS), updated a-FRS (ua-FRS), and the Modified Fistula Risk Score. These tools are being increasingly used in surgical planning to better manage the risks of surgery and improve patient outcomes.

FAQs

  1. What is the Whipple procedure?
  2. What is a common complication after the Whipple procedure?
  3. What are the scoring systems developed to predict the risk of complications after the Whipple procedure?

Doctor’s Tip

A doctor might tell a patient undergoing a Whipple procedure to follow post-operative care instructions carefully, including maintaining a low-fat diet, avoiding heavy lifting, and attending follow-up appointments. They may also advise the patient to watch for signs of infection or pancreatic fistula, such as fever, abdominal pain, or abnormal drainage from the incision site, and to seek medical attention if these symptoms occur. It is important for patients to communicate any concerns or changes in their condition to their healthcare provider promptly to ensure proper monitoring and treatment.

Suitable For

Patients who are typically recommended for the Whipple procedure include those with:

  1. Pancreatic cancer: The Whipple procedure is commonly used to treat pancreatic cancer that is confined to the head of the pancreas.

  2. Pancreatic cysts: Large or symptomatic pancreatic cysts may require surgical removal using the Whipple procedure.

  3. Chronic pancreatitis: Severe cases of chronic pancreatitis that do not respond to other treatments may require the Whipple procedure.

  4. Ampullary tumors: Tumors located in the ampulla of Vater, where the pancreatic and bile ducts meet, may be removed using the Whipple procedure.

  5. Neuroendocrine tumors: Some types of neuroendocrine tumors in the pancreas may require surgical removal through the Whipple procedure.

It is important for patients to undergo a thorough evaluation by a multidisciplinary team of healthcare professionals to determine if they are suitable candidates for the Whipple procedure. Additionally, the use of scoring systems to predict the risk of complications, such as pancreatic fistulas, can help guide surgical decision-making and improve patient outcomes.

Timeline

Before the Whipple procedure:

  • Patient will undergo various diagnostic tests such as imaging studies and blood tests to confirm the need for surgery and assess the extent of the disease.
  • Patient will receive pre-operative counseling and education about the procedure, potential risks, and post-operative care.
  • Patient may undergo a pre-operative preparation period which may include dietary restrictions and cessation of certain medications.
  • Patient will undergo the Whipple procedure which involves the removal of the head of the pancreas, part of the small intestine, the gallbladder, and sometimes part of the stomach.

After the Whipple procedure:

  • Patient will be closely monitored in the recovery room for immediate post-operative complications.
  • Patient will be transferred to a hospital room for further recovery and monitoring.
  • Patient will be started on a clear liquid diet and slowly progress to solid foods as tolerated.
  • Patient will receive pain management medications to help with post-operative discomfort.
  • Patient will undergo physical therapy to regain strength and mobility.
  • Patient will have follow-up appointments with their surgeon to monitor healing and address any post-operative complications.
  • Patient may require additional treatments such as chemotherapy or radiation therapy depending on the stage and extent of the disease.
  • Patient will need to make lifestyle changes such as following a special diet and taking pancreatic enzyme supplements to aid digestion.

What to Ask Your Doctor

  1. What is the purpose of the Whipple procedure and why is it recommended for me?
  2. What are the potential risks and complications associated with the Whipple procedure, including the risk of developing a pancreatic fistula?
  3. How experienced are you in performing the Whipple procedure and what is your success rate?
  4. How will my recovery process look like after the surgery and how long will it take to fully recover?
  5. What steps can I take to reduce my risk of developing a pancreatic fistula after the surgery?
  6. How will my dietary and lifestyle habits need to change after the Whipple procedure?
  7. What follow-up appointments and tests will I need to undergo post-surgery to monitor my recovery and check for any complications?
  8. Are there any alternative treatments or procedures that I should consider before deciding to undergo the Whipple procedure?
  9. What are the long-term effects and potential complications of the Whipple procedure that I should be aware of?
  10. Are there any support groups or resources available for patients who have undergone the Whipple procedure to help with recovery and adjustment to post-surgery life?

Reference

Authors: Kovalenko ZA, Efanov MG. Journal: Khirurgiia (Mosk). 2021;(7):71-76. doi: 10.17116/hirurgia202107171. PMID: 34270197