After your Whipple's operation

I want you to understand that there are long term complications of the Whipple’s operation. We anticipate:

1.       Malabsorption – we have removed part of your pancreas in order to clear the cancer. However this also mean that less of pancreatic secretions are available to digest your food. The complex connection sin the intestine after the whipple operation also hinders the appropriate mixing of intestinal secretions with food. Both these lead to some decrease in absorption of food.  We have provided you with pancreatic enzyme supplements, which must be chewed with food. You must always be on the watch for loss of weight. You will start gaining weight and will feel more energetic after the first month of surgery.

2.       Diabetes - Patients who have completely normal blood sugar prior to surgery with no history of diabetes and do not have chronic pancreatitis or morbid obesity have a low probability of developing diabetes after the Whipple’s operation. However, we advise you to check the blood sugars every month after the operation.

3.       Alteration in diet - After a Whipple’s operation, we generally recommend that the patients ingest smaller meals and snack between meals to allow better absorption of the food and to minimise symptoms of feeling of being bloated or getting too full. Approximately one in five patients who have a Whipple’s operation have a temporary problem in which the stomach does not empty well after eating. This may cause nausea, vomiting, and loss of appetite. It usually resolves on its own within 2-6 weeks after the operation.

Loss of weight

You could lose up to 5 to 10% of their body weight compared to their weight prior to their illness. The weight loss usually stabilizes very rapidly and most patients after a small amount of initial weight loss are able to maintain their weight and do well.

Passing drain tubes in stool

We have placed one soft piece of plastic tubing during your surgery to hold open your pancreatic duct. These may pass with your bowel motion at any time after your surgery. It is common not to notice them. If you do notice them, it is completely normal. You need not retrieve them from the toilet.

The feeding jejunostomy tube

Our policy is to leave the feeding tube for a month when the tube will become loose and can be pulled out. If it falls off on its own, you need not bother except that you should inform your doctor about it. In case it has not fallen after 1 month, please consult your surgeon.

How you may feel?

1.       You may feel weak when you go home. You might want to nap often. Even simple tasks may exhaust you.

2.       You might have trouble concentrating or difficulty sleeping. You might feel depressed. These feelings are usually transient and can be expected to resolve in 2-4 weeks.

3.       Your surgeon will discuss with you which medications you should take at home. 

Caring for your incision

1.       Your dressing will be removed before you leave the hospital and if it is not leaking it will be left open to the air. You may wear cloths over the top of it.

2.       Your incision may be slightly red along the cut. This is normal. You may gently wash dried material around your incision and let water run over it. Pat dry gently with a towel. Do not rub soap or moisturizer into your incision until at least 4 weeks or it is fully healed.

3.       It is normal to feel a ridge along the incision. This will go away. It is normal to have a patch of numbness under the wound. There may be numbness in the part below the cut area. The sensation may not return to normal.

4.       Do not use any ointments on the incision unless you were told otherwise.

5.       Over the next few months your incision will thin down and become less visble.

These are the activity restrictions that you must follow

1.       Do not drive your car until you feel you could respond in an emergency.

2.       You can climb stairs.

3.       You can go outside, but avoid travelling long distances until are comfortable.

4.       Don’t lift more than 10kg for 12 weeks. This especially applies to lifting children, but they may sit on your lap.

5.       You may start some light exercise when you feel comfortable.

6.       You can swim after 8 weeks.

7.       Heavy exercise may be started after 6 months – but use common sense and go slowly at first. It is more important to keep yourself active even if you cannot do a heavy exercise.

8.       You may resume sexual activity when you feel ready.

If you have undergone your Whipple’s operation for a cancer:

1. Understand that removal of the cancer by surgery is only one part of the treatment.
2. Once you recover well, you will need to see your cancer doctor.
3. The cancer doctor will prescribe medicines that control your cancer. You might have to take the medicines for 6 months. 
4. Patients whose cancer has not spread to the lymph nodes have a better survival than those in whom the cancer has spread to the lymph nodes. 
5. The risk of cancer coming back is very high in pancreatic cancer. In fact, there has been no cure for pancreatic cancer as of today. Once the patient develops pancreatic cancer, the patient has a very high chance for it to come back. A good result of treatment will extend your life by 5 – 7 years.