Consent: Whipple Procedure
This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent.
Overview of Procedure
A Whipple procedure (or pancreaticoduodenectomy) involves removal of the head of the pancreas, and portion of the bile duct, the gallbladder and the duodenum, along with part of the stomach, which are then all rejoined to the intestine.
Figure 1 – A Whipple procedure (A) Pre-procedure (B) Post-procedure
Complications
Intra-Operative
| Complication | Description of Complication | Potential Ways to Reduce Risk |
| Haemorrhage | Damage to any of the surrounding structures or blood vessels. | |
| Injury to surrounding structures including bowel, liver and spleen | This is a major operation, and surrounding structures can be damaged in the process. | |
| Anaesthetic risks | Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications. | Forms a part of the anaesthetist assessment before the operation |
Early
| Complication | Description of Complication | Potential Ways to Reduce Risk |
| Pain | The patient will most likely have an epidural or patient controlled analgesia for post-operative control | |
| Infection | Superficial wound infection is common, however collections in the pelvis or paracolic gutters can also occur. Chest infections are also common following, due to reduced lung expansion secondary to pain | Peri-operative antibiotics will reduce the risk of wound infections. Early mobilisation, optimal analgesia, and encouraging breathing exercises reduces the risk of lower respiratory tract infections |
| Anastomotic leak | The anastomotic site may have insufficient blood supply due to ligation of the corresponding arteries. These may break down requiring further surgery. | |
| Pancreatic fistula | As with anastomotic leak, this frequently requires re-laparotomy and/or drainage | |
| Blood clots | DVTs and PEs are a possibility in any operation. The risk is increased in patients with a raised BMI, on the pill, recent flights, previous DVT, pregnancy, smokers, cancer and prolonged bed rest. | The patient will be given anti-embolism stocking and low molecular weight heparin peri-operatively to minimise this risk as deemed appropriate. |
| Stroke, MI, Kidney Failure, Death | Although small, this is always a risk in any major surgery |
Late
| Complication | Description of Complication | Potential Ways to Reduce Risk |
| Adhesions | Abdominal surgery may cause adhesions as a reaction to the procedure, which in turn can cause adhesional bowel obstruction | |
| Delayed gastric emptying | Some digestive systems take longer to recover, potentially requiring NG feeding for a few weeks. | |
| Diabetes mellitus | Due to resection of a large portion of the pancreas this will increase the risk of developing diabetes. |
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