Our Summary

This research paper looks at the results of a specific surgery, known as the Whipple’s procedure (WP), performed on 404 patients from 2007 to 2019. The study also pays special attention to how a pre-surgery procedure called preoperative biliary drainage (PBD) affects patients’ health after the surgery.

The average age of patients at the time of surgery was 50 years, and over half of them experienced complications after the surgery. The most common issue was infection at the surgical site. Other complications included delayed stomach emptying, fluid build-up in the abdomen, and bleeding after surgery.

The study found that PBD was performed in about 43% of the patients. These patients experienced more overall complications and infections after surgery compared to those who didn’t have PBD. However, the study found no significant difference in the rate of major complications or deaths between the two groups.

The time between PBD and surgery, even if it was more than 6 weeks, didn’t lead to more complications or longer hospital stays. The research also found that performing PBD based only on a high level of a certain type of substance in the blood (bilirubin) didn’t improve the surgical outcome.

The death rate within the group of patients who had the surgery was 4.2%, and the average hospital stay after the surgery was 13 days.

In simple terms, PBD seems to increase the risk of complications and infections after surgery but has no effect on more serious complications or the risk of death. The time between PBD and surgery, and the level of bilirubin in the blood, don’t seem to affect the results of the surgery.

FAQs

  1. What is the overall morbidity rate in patients who underwent the Whipple’s procedure?
  2. Does the preoperative biliary drainage (PBD) have any impact on the postoperative clinical outcome of the Whipple’s procedure?
  3. Is there a significant difference in postoperative major complications or mortality between PBD and no-PBD patients?

Doctor’s Tip

A helpful tip a doctor might tell a patient about Whipple procedure is to discuss with your healthcare provider the necessity of preoperative biliary drainage (PBD) before the surgery. While PBD may be recommended in some cases, it is important to weigh the potential benefits against the increased risk of postoperative complications such as surgical site infection. Additionally, it is important to note that the timing of PBD, specifically the stent-surgery interval, does not significantly impact postoperative outcomes. Ultimately, the decision to undergo PBD should be individualized based on each patient’s specific situation.

Suitable For

The Whipple procedure is typically recommended for patients with pancreatic cancer, ampullary cancer, bile duct cancer, and other tumors involving the pancreas, bile ducts, or duodenum. Patients with benign pancreatic or biliary diseases such as chronic pancreatitis, pancreatic cysts, or benign tumors may also undergo a Whipple procedure in certain cases. The decision to recommend a Whipple procedure is based on the specific diagnosis, stage of the disease, overall health of the patient, and other individual factors.

Timeline

  • Pre-Whipple Procedure:
  1. Patient is diagnosed with a condition that requires a Whipple procedure, such as pancreatic cancer or pancreaticoduodenal tumors.
  2. Patient undergoes preoperative evaluation and imaging studies to assess the extent of the disease and determine if they are a suitable candidate for surgery.
  3. If necessary, the patient may undergo preoperative biliary drainage to relieve symptoms of jaundice.
  4. Surgery is scheduled and the patient undergoes preoperative preparation and counseling.
  • Whipple Procedure:
  1. Patient undergoes the Whipple procedure, a complex surgery that involves removing a portion of the pancreas, duodenum, bile duct, and sometimes part of the stomach.
  2. The surgery typically lasts several hours and may involve complications such as postoperative pancreatic fistula (POPF), delayed gastric emptying, intra-abdominal collection, and postpancreatectomy hemorrhage.
  3. The patient is closely monitored in the postoperative period for any signs of complications and may require additional interventions or treatments.
  • Post-Whipple Procedure:
  1. Patient recovers in the hospital for an average of 13 days, although this may vary depending on individual factors and any postoperative complications.
  2. Patient is discharged from the hospital and continues to recover at home, following a strict diet and medication regimen as prescribed by their healthcare team.
  3. Patient undergoes follow-up appointments with their healthcare team to monitor their progress and address any concerns or complications that may arise.
  4. Long-term follow-up may involve imaging studies, blood tests, and other monitoring to assess the success of the surgery and any potential recurrence of the disease.

What to Ask Your Doctor

  1. What are the potential risks and benefits of undergoing a Whipple procedure?
  2. How long is the recovery period after a Whipple procedure?
  3. What can I expect in terms of pain management after the surgery?
  4. Will I need to make any dietary or lifestyle changes following the procedure?
  5. How frequently will I need to follow up with my healthcare provider after the surgery?
  6. Are there any long-term side effects or complications associated with a Whipple procedure?
  7. How many Whipple procedures have you performed, and what is your success rate?
  8. What is the postoperative care plan for managing potential complications such as surgical site infection or delayed gastric emptying?
  9. How will the removal of part of my pancreas, bile duct, and small intestine affect my digestion and overall health?
  10. Are there any alternative treatment options to consider before undergoing a Whipple procedure?

Reference

Authors: Ray S, Das S, Mandal TS, Jana K, Das R, Kumar D, Ansari Z, Khamrui S. Journal: Updates Surg. 2021 Oct;73(5):1735-1745. doi: 10.1007/s13304-021-01038-y. Epub 2021 Apr 3. PMID: 33811607