How to Prepare for Whipple's Surgery?

1. Written informed consent

Carcinoma head of the pancreas is a curable cancer if if identified early. The curative surgical procedure is Whipple's procedure also known as pancreaticoduodenectomy. Whipple's procedure is major operation. Your doctor will explain you the condition and the options you have. He will also tell you the risks of the procedure. Then he will take an informed written consent. You should be fit enough to undergo this procedure, because of the cormorbidities associated with the procedure. Therefore, your doctor will ran you through a series of investigations to assess your fitness. 

2. Investigations

 Carcinoma of the pancreas is associated with high level of morbidity. If you are diagnosed to carcinoma of head of the pancreas, you must have suffered months of severe loss of appetite and loss of weight. Severe loss of appetite and loss of wight makes you nutritionally deprived. Therefore, you must be having several deficiencies.

• PT/INR

Vitamin K deficiency is one important nutritional deficiency you can get is you have carcinoma head of pancreas. If you are deprived of this particular vitamin, your blood's ability to clot and prevent bleeding will be impaired. Therefore, your will assess your vitamin k levels by measuring the ability of your blood to coagulate. This is done by measuring the prothrombin time and the international normalize ratio shortly known as PT/INR. If this is high, your coagulation status will be corrected by giving intravenous Vitamin K. Usually 10 mg of vitamin K is given 12 hourly for 3 days. If not you wll be transfused with fresh frozen plasma.

• Serum total protein and albumin levels

Protein and albumin can also be deficient in your body. Hypoalbuminemia is associated with many post-operative complications. Protein deficiency can delay wound healing and thereby increase the hospital stay. When you are deficient of protein, you are a high risk of developing infections, anastomotic leakage, burst abdomen, incisional hernia and intra-abdominal sepsis. Therefore, it is important to measure the serum protein levels and correct them if there is any deficiency. Doing this by increasing oral intake can be a challenge both due to severe loss of appetite and due to malabsorption.

• Full blood count

Usually people who get carcinoma of the pancreas are elderly people. They usually have other cormorbid conditions. Therefore, routine investigations are done to detect those diseases. From the full blood count report your doctor will look at your hemoglobin levels, white cell count, platelet count and the hematocrit. 

• Renal Function Tests

Blood urea, serum electrolyte levels and serum creatinine levels are measured.

3. Routine pre-operative preparations

• Good hydration 

Your doctor will keep you adequately hydrated. It is important to keep your body hydrated because it can prevent post-operative hepatorenal syndrome. Hepatorenal syndrome is renal desfunction occurring along with hepatic disease. 

• Prophylactic antibiotics 
• Six hour fasting
• Booking a intensive care unit bed

Whipple's procedure is a major surgery. You might require intensive care after the procedure. Therefore, your doctor will book a bed in the intensive care unit prior to the surgery. 

Once all above requirements are full filled, you will be sent to the theater. At the theater, the surgeons, anaesthetists and other theater staff will take care of you. All you have to do is try to keep calm.