The Whipple Procedure
By Rhonda Mann
Beth Israel Deaconess Medical Center Staff
It is the "Cadillac" of operations, one of the most complex abdominal procedures performed. But for many patients whose pancreas is their target of disease, the Whipple Procedure provides the only hope for a cure.
"The Whipple Procedure is a major resection of the head of the pancreas that also involves removing key neighboring anatomy related by blood supply," says
Dr. Mark Callery, Chief of the Division of General Surgery and specialist in pancreatic surgery at Beth Israel Deaconess Medical Center. "Parts of the biliary system, the pancreas, the duodenum and sometimes the stomach all need to be removed so we can get to the tumor, cyst or diseased area. Next, everything must be reassembled so the patient can live a normal life."
Also called a pancreaticoduodenectomy, this operation was invented in the 1930s by surgeon Allen Oldfather Whipple. In its early years, mortality rates were unacceptably high, but by the mid 1980s, through advances in anesthesiology, more appropriate patient selection and refined training of specialist surgeons, it became a much safer procedure.
"This is a highly specialized operation that has been proven to be safer at high-volume medical centers that usually attract surgeons with advanced training," explains
Dr. Charles Vollmer, a pancreatic surgeon at Beth Israel Deaconess Medical Center. "Many Whipples are performed at these types of institutions and their outcomes are accordingly better."
Vollmer says at hospitals which infrequently perform this major operation, the mortality rates within 30 days of surgery can be as high as 15 percent. At Beth Israel Deaconess Medical Center, the mortality rate is below 1.4 percent. Part of that difference is a process of high-volume patient care called a clinical pathway. The pathway is a checklist of accomplishments the patient is expected to make each day during their 7-8 day hospital recovery, from when their nasogastric tube should be removed, to the level of pain medications they may need as their recovery progresses.
"Our patients know when they leave our office what to expect when they return for their Whipple procedure," says Callery. "On the wall near their bed, everything, each benchmark, is spelled out in detail. So the patient enters the hospital with less mystery. They know what we expect of them, what they can expect of us so really all they have to bring is their motivation. If they deviate from the pathway for any reason, our team knows to respond quickly."
The pathway also allows doctors to constantly track results and identify areas to improve. And it puts all the medical caregivers on the same page, from nurses, to anesthesiologists, to social workers.
"We ask you to join our team approach here to make certain that this stressful situation passes as comfortably for you as possible, so you can go back and reclaim your life, healthy," says Callery.
"It does take the wind out of your sails-- not only the operation, but the process of having the disease," adds Vollmer. "But usually within 3 months, patients are back to where they were before they got sick. It's extremely gratifying."
Above content provided by Beth Israel Deaconess Medical Center.
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Posted March 2009