What is a pancreatic resection?

A pancreatic resection or as it is sometimes called, a "Whipple’s Procedure", is an operation to remove part of the pancreas, the gall bladder, some of the bile ducts and a piece of the small bowel. Sometimes a portion of stomach is also removed. It is normally, although not always, performed for cancer of the pancreas or of other organs which surround the pancreas and requires major surgery which can take up to eight hours.

How long will it take for me to recover?

You can expect to be in hospital for around 14 days and sometimes longer. It normally takes up to three months until you are back to your normal activities.

Will I have a wound?

You will have a fairly large wound across the upper part of your stomach or up and down the centre of your abdomen.

Will I become disabled in any way after the operation?

Although it takes some time for you to recover you should be able to return to your normal lifestyle after the operation. There may however be some lasting changes to your digestive system which could mean that you will need to take tablets or even insulin injections for the rest of your life.

We will ask you to come into hospital on the day before your surgery. This will allow us to make sure that all the necessary tests and investigations have been made.

The following preparations will be made on the day of your surgery:

High Dependency Unit (HDU) bed

After your operation you will be cared for in the High Dependency Unit and it is essential that there is a bed available for you before your operation starts. If no high dependency bed is available on the day of your operation then your operation will be rescheduled for another day.

It can be very disappointing to prepare for a major operation and then be sent home. We do understand this disappointment. We have no control over the availability of the beds. It helps if you are prepared for this possibility.

Fasting

You will need to fast in preparation for your surgery. This means that you should not eat or drink within six hours of your operation. If you are diabetic a special regime of glucose and insulin will be given through your drip and your blood glucose level will be closely monitored.

Pre-medication

Your anaesthetist may prescribe a sedative (pre med) for you before you go to theatre. This will help you relax and be prepared for your surgery.

During your operation you will be looked after by a team of anaesthetists, theatre nurses and surgeons and you will be closely monitored until you are fully awake.

Your surgeon will send samples of the tissue removed to the laboratory for examination. The results of this will be available for you in around two weeks.

It is very important in the first 24 hours after your operation that we are able to monitor your condition closely. For the first few hours after your operation you will be cared for in the High Dependency Unit on Level 3 of the Freeman Hospital.

There are a number of checks, which are normal and are part of the routine care for anyone having your operation. The Unit will regularly monitor the following:

Oxygen levels:  Following your anaesthetic, you will require some extra oxygen. Oxygen helps you to recover. This will be given through a face mask. On occasions this may be a little uncomfortable but it is important for you.

If you are finding it too difficult you may be given oxygen through nasal prongs which some people find more comfortable. Nasal prongs are tubes that fit into both your nostrils and deliver the oxygen directly into your nose when you breathe in. Your oxygen levels will be monitored with a small probe that sits on your finger.

The physiotherapist will visit you every day and help you with some breathing exercises, which will help keep your lungs clear, to maintain your oxygen levels.

Blood pressure, pulse and temperature:  Your blood pressure and pulse will be closely watched to check for any signs of complications after your operation. Also your temperature will be monitored to check for any signs of infection. A sharp rise in your temperature may indicate that you have an infection although it is normal within the first 24 hours of surgery for your temperature to increase slightly as part of your body’s normal response to your surgery.

Fluid requirements:  There will be a tube into a vein in your neck that will allow us to accurately monitor your fluid requirements and also to administer the fluids which you will require initially when you are not eating or drinking normally. This will prevent you becoming dehydrated. You may also have a drip in your arm.

Pain control:  It is very important that you are comfortable and pain free after your operation to allow you to breathe properly and to help you to move about as soon as possible. To achieve this you will be given an epidural during your operation. This is a small tube into your spine through which strong painkillers can be given. After a few days, once you are drinking normally again, you can take regular tablets to help the pain and your epidural will be removed.

Blood sugar levels:  Your blood sugar levels will be watched closely after your operation. This is because one of the functions of the pancreas is to produce insulin which is the substance in the body that helps control sugar levels. Nurses will regularly take a small amount of blood from your fingertip. Initially this will be performed every few hours but will happen less frequently after a few days.

Catheter:  When you pass urine it is a sign that your kidneys are working. To allow us to closely monitor this important function you will have a catheter placed in your bladder for a few days after your operation. This will be inserted after you are given your general anaesthetic and is therefore not painful or uncomfortable. After you are able to move around freely, the catheter will be removed. This can be done in the ward and may be a little uncomfortable but not painful.

Wound drains:  Two small tubes will be inserted during your operation which will drain away any excess fluid from around the site of your surgery. In order to observe for any complications the level of amylase (a substance produced by the pancreas) in the fluid will be sent to the laboratory and measured daily. Sometimes this fluid leaks from around the drains and not into the drainage bags as planned. This may cause you some discomfort but it does not mean that there is anything is seriously wrong. Your dressing will be changed regularly to keep you comfortable.

Jejunostomy tube:  It will be a few days after your operation before you are able to eat and drink normally. Because of this, and because you have probably lost some weight while waiting for your surgery, we may give you some liquidised food through another small tube in your bowel called a jejunostomy tube. This feed will be increased gradually to give you the nutrients which you require until you are eating normally again.

This tube is usually not removed until after you are home and will be taken out when you visit the clinic two weeks after you are discharged.

Nasogastric tub:  During your operation a small tube will be inserted through your nose and your throat into your stomach. This will help keep your stomach empty after your surgery. Although your stomach will not be full from food, you may have a build up of gastric fluid and bile which can be uncomfortable and make you feel sick.

When you no longer require it the nurses on the ward can remove the nasogastric tube easily.

Blood samples:  In the first few days we will need to take blood samples from you at least once a day, if not more frequently. This is part of the careful monitoring process. As you recover from your surgery we will need to take blood less frequently.

Visitors:  It is natural for your friends and family to want to visit you after your surgery. However, we do recommend that only close family visit for the first few days after your operation. This is because initially you will tire very easily and need lots of rest. Once you are feeling better you can have more visitors.

After a short period in the High Dependency Unit you will be transferred to a ward to be cared for by an experienced nursing and medical team.

Eating and drinking:  You can start drinking small amounts again the day after your operation and eating within the next few days. Your nasogastric tube will need to stay in place initially when you start to eat again. Remember that your appetite may not be back to normal straight away but it helps if you can eat a little at normal mealtimes and also to drink plenty of fluid. This allows your drips to be removed.

The liquidised food that is being given through your jejunostomy tube will continue until your own food intake is sufficient for your needs.

Wound care:  You will have a fairly large wound in your upper abdomen which will be closed by small metal clips. This will be checked every day to ensure that it is healing well. If your wound is clean and dry it will be left without a dressing on and you can bathe or shower as normal, taking care not to use any strong soaps or creams around the area. It may be that your wound leaks some darkish fluid or looks a little inflamed. This is not unusual and the nurses will observe it closely.

Let the nurses know if you notice any swelling or redness around your wound or if you start to feel ‘flu-like’. This may be a sign that you are developing a wound infection. This can normally be treated with antibiotics and careful monitoring.

Stitches:  Your stitches or staples will be taken out after 10 days. By then your wound should be fully healed. Even if the outer layer is not, the layers underneath the skin have been well secured at the time of operation and will be well healed.

Getting back to normal

Within a few days of your operation you will be able to get up and around the ward for short periods and may be able to go home 10 - 14 days after your operation. Do not worry if you need to stay in hospital for longer than this. Each person’s body heals at a different rate. Being up and about early reduces the risk of the formation of blood clots (DVT or Deep Vein Thrombosis) and pressure sores.

After any major operation it takes some time to get back to feeling yourself again. Once all the tubes and drains have been removed you may still tire easily and feel emotionally upset. This is normal and as time passes you will begin to feel more like yourself again. Try to be patient with yourself and allow yourself some time to get over your operation.

The physiotherapist will visit you in the ward and make sure that you are managing. She or he will give you some simple exercises which will help you regain your strength.

The dietician will also visit you to give you advice about your diet and will prescribe supplement drinks if you need them.

After you are home

Once you are home you can really start the process of getting back to normal. Initially your stomach will feel heavy and you will still need to take regular painkillers.

Also you will tire very easily and need to keep ‘toddler hours’ - get up and go to bed early and take a short nap in the afternoon. If you are having difficulty sleeping try to avoid caffeine or heavy meals in the early evening. In a few weeks though you will find yourself gradually getting back to normal.

Your follow up care 

You will be called to see your Consultant in the Outpatients’ Department two weeks after your surgery. Your appointment may be posted to you once you are home or given to you before you leave the ward. This will allow us to check that you are making good progress and to offer help if you need it.

At this appointment the doctor will have the results of the tissue samples which were taken during the operation and will discuss these with you. Further treatment will be discussed if appropriate.

You will be asked to see your Consultant and/or the specialist nurse at regular intervals for up to five years after your surgery.

If your operation has been for cancer we would like to monitor you for any signs that the cancer may be returning. We will do this by checking blood tests every three months for the first year after your operation, then less frequently, every 4 - 6 months thereafter. If we find abnormalities in any of your tests we will write to you to ask you to come to the clinic sooner than planned to discuss what further treatment you might need.

Are there ever any complications?

As with all surgery, there are sometimes problems which can arise either during surgery or after your operation is finished. In the main these are problems which your consultant and his specialist team can deal with. Listed below are some of the complications that are most common after a pancreatic resection. Please be aware that you are unlikely to develop all of the complications listed below and you may never develop any of them.

Wound infection:  Some patients develop an infection in their wound. This slows down the rate at which the wound heals. Infections are treated promptly on the ward with antibiotics and dressings.

Bleeding:  Bleeding is normal during the operation and is dealt with by the surgeon. If it continues after the operation you may be given a blood transfusion. If bleeding continues you might need to return to the operating theatre.

Pancreatic Leakage:  A small amount of leakage of pancreas fluid is normal after the operation which is why you will have a fine tube draining the wound. To monitor the amount of fluid the level of amylase (a substance produced by the pancreas) in the fluid of your wound drain will be sent to the laboratory and measured daily.

Diabetes:  There is a chance that the removal of part of your pancreas may result in you becoming diabetic. If this happens you may need to take regular insulin injections or tablets.