Our Summary

This research paper discusses the use of two common practices in surgery for pancreatic cancer: preoperative drainage of the bile duct (the tube that carries bile from the liver to the small intestine) and use of drains after surgery.

Some doctors believe these practices are unnecessary and could actually cause more complications. This paper reviews the evidence both supporting and challenging these practices.

For preoperative drainage, it suggests that doctors should decide on a case-by-case basis, considering various factors. It also reviews the reasons for and against using drains after surgery. The paper concludes that drains should be used routinely after pancreatic surgery.

FAQs

  1. What is the Whipple procedure and what does it involve?
  2. Is preoperative biliary decompression necessary before a pancreaticoduodenal resection?
  3. What is the evidence for the routine use of surgical drains after a pancreaticoduodenal resection?

Doctor’s Tip

A doctor might advise a patient undergoing a Whipple procedure to discuss the need for preoperative biliary drainage with their healthcare team. They may also recommend discussing the use of intraabdominal drains following the procedure to determine if they are necessary based on individual factors. It is important to have an open and informed discussion with your healthcare provider about the best approach for your specific situation.

Suitable For

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

  • Pancreatic cancer
  • Ampullary cancer
  • Distal bile duct cancer
  • Chronic pancreatitis
  • Pancreatic neuroendocrine tumors

Patients with benign tumors or other conditions that affect the pancreas, bile ducts, or duodenum may also be recommended for a Whipple procedure. The decision to undergo a Whipple procedure is typically made after a thorough evaluation by a multidisciplinary team of healthcare providers, including surgeons, oncologists, and radiologists.

Timeline

Before Whipple Procedure:

  • Patient is diagnosed with a pancreatic or periampullary tumor
  • Patient undergoes various imaging tests such as CT scans, MRIs, and endoscopic ultrasound to determine the extent of the tumor
  • Patient may undergo preoperative biliary drainage if they are experiencing jaundice due to obstruction of the bile duct
  • Patient may undergo chemotherapy and/or radiation therapy to shrink the tumor before surgery

After Whipple Procedure:

  • Patient is monitored closely in the intensive care unit for the first few days post-surgery
  • Patient gradually resumes eating and drinking, starting with clear liquids and progressing to solid foods
  • Patient may experience complications such as infection, pancreatic leak, or delayed gastric emptying
  • Patient may require a longer hospital stay for monitoring and management of complications
  • Patient undergoes follow-up appointments and imaging tests to monitor for recurrence of the tumor

Overall, the patient may experience a significant recovery period after the Whipple procedure, with gradual improvement in their symptoms and overall health.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with the Whipple procedure?
  2. How long is the recovery period after the Whipple procedure?
  3. What is the success rate of the Whipple procedure in treating pancreatic cancer?
  4. Will I need any additional treatments or therapies after the Whipple procedure?
  5. What is the likelihood of the cancer returning after the Whipple procedure?
  6. Will I need to make any lifestyle changes after the Whipple procedure?
  7. What is the expected outcome or prognosis after the Whipple procedure?
  8. How many Whipple procedures have you performed and what is your success rate?
  9. Will I need to have any follow-up appointments or tests after the Whipple procedure?
  10. Are there any alternative treatment options to the Whipple procedure that I should consider?

Reference

Authors: Iskandar ME, Wayne MG, Steele JG, Cooperman AM. Journal: Surg Clin North Am. 2018 Feb;98(1):49-55. doi: 10.1016/j.suc.2017.09.004. PMID: 29191277