Whipple procedure

The Whipple procedure (or partial pancreaticoduodenectomy) is considered the definitive surgical operation to resect carcinoma in the head of the pancreas, periampullary carcinoma, or duodenal carcinoma 1.

In the procedure, the head of the pancreas and adjacent duodenum is resected. The gallbladder is also removed. Three anastomoses are then created between the bowel and the liver, stomach, and pancreas. A nodal resection is also performed. The end result includes:

  • resection of pancreatic or duodenal primary
  • gastrojejunostomy (or duodenojejunostomy)
  • hepaticojejunostomy
  • pancreaticojejunostomy
  • cholecystectomy

The classic Whipple procedure involves resection of the gastric antrum, but in appropriate patients a "pylorus-preserving" Whipple may be performed, which results in improved postoperative functional outcome.

A Whipple procedure can be assumed if the features listed above are present. CT is useful for evaluation of complications:

  • gastric outlet obstruction / delayed gastric emptying
  • anastomotic leakage (usually occurs within two weeks)
  • pancreatic fistula
  • pancreatitis of the residual gland
  • biliary stricture
  • wound infection
  • abdominal abscess
  • intra-abdominal hemorrhage
  • other
    • hepatic infarction
    • portomesenteric venous thrombosis

CT protocols for evaluation of the postoperative Whipple procedure are often customized to the individual center and discussion between surgeon and radiologist. IV contrast is often used. Postive oral contrast is often helpful for evaluation of anastomic leakage, but may obscure intra-abdominal hemorrhage.

Recurrence of carcinoma after resection can sometimes be difficult to determine on early postoperative studies, due to postoperative change and possible radiation change to the operative bed. A combination of serial CT exams and/or FDG-PET may be necessary to suggest recurrence.

The procedure is considered one of the most invasive in abdominal surgery and the risk of adverse events and recurrence of the primary tumour is high. This can be improved somewhat if the procedure is performed at a high-volume center.

Tumor-specific 10-year actuarial survival rates post procedure depend on the underlying cancer (1998 data) 3:

  • pancreatic: 5%
  • ampullary: 25%
  • distal bile duct: 21%
  • duodenal: 59%

The classic Whipple procedure and the pylorus-preserving Whipple procedure have similar morbidity and mortality 4.

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Article information

rID: 32007
Synonyms or Alternate Spellings:
  • Pancreaticoduodenectomy
  • Whipple
  • Kausch-Whipple procedure

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