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Pylorus-Sparing Whipple Procedure

The Whipple or Pancreaticoduodenectomy is a surgical procedure that involves removal of the head of the pancreas, the duodenum, a portion of the stomach, the gallbladder and a portion of the bile duct. The pylorus sparing Whipple is a modified version of the conventional Whipple where the bottom portion of the stomach or pylorus is not removed. This modification was developed because of concerns that the conventional Whipple was responsible for excessive weight loss and nutritional problems.

  1. Whipple History

    • The conventional Whipple procedure was developed by Allen Oldfather Whipple, former chairman of the Department of Surgery at Columbia University, and is the most common surgical procedure for the treatment of pancreatic cancer.

    Whipple Complications

    • Delayed gastric emptying is a common complication of the Whipple procedure. This condition occurs when the stomach takes longer than normal to empty. Seven to ten days after the Whipple, the stomach should be emptying properly. If this does not happen, a feeding tube may become necessary. The emptying problem can continue for another 7 to 10 days or for as long as a few weeks. Abdominal infection can occur if there is leakage where the pancreas is reattached to the intestines. Approximately 10 percent of patients develop abdominal infections requiring a combination of drainage tubes, antibiotics and supplemental feeding tubes. Long-term side effects include digestive difficulties

    Modifications to the Whipple

    • The pylorus sparing Whipple, also called pylorus-preserving Whipple, was developed to maintain the gastric reservoir function and to facilitate normal gastric emptying. The hope was that this modification would reduce or eliminate complications associated with delayed gastric emptying.

    Clinical Studies

    • Clinical studies comparing the post-surgical results of the conventional Whipple to the pylorus sparing Whipple have shown no significant differences for complications including gastric emptying, long-term survival or death. In some instances however, operating time and blood loss seemed to be lower in the pylorus-preserving Whipple operation.

    Hirshber Foundation Study

    • The Hirshberg Foundation for Pancreatic Cancer Research recently published findings from a randomized prospective study that compared the standard Whipple to the pylorus preserving Whipple. The study results indicated no distinct disparities between the two procedures with regard to postoperative complications, nutritional parameters, the frequency or type of gastrointestinal symptoms, weight loss, or in the case of time required to perform the two operations.

    Considerations

    • Where both the conventional Whipple and the pylorus sparing Whipple have proven equally effective the two procedures are done interchangeably. However, the pylorus sparing technique is the preferred method for patients with smaller, less extensive tumors.

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