Whipple Procedure in Morbid Obesity – Case Report

Abstract Background Whipple procedure, or cephalic pancreaticoduodenectomy is a complex and major surgery reserved for pancreas head cancer or pancreatic ductal carcinoma. The intervention can be completed successfully, with low rates of morbidity and mortality in high volume medical centers or by experienced surgeons. Although this solution was reserved for early stages, it has now been applied increasingly in cases which benefited from neoadjuvant chemotherapy. Case presentation The patient is a 68-year-old male, of 130 kg weight and BMI 40 (Class III Obesity). He was diagnosed with pancreatic head cancer and was proposed the surgical treatment of Whipple Procedure. He underwent the intervention of cephalic pancreaticoduodenectomy, Blumgart pancreato-jejunal anastomosis with trans-Wirsung stent. The gastro-enteric anastomosis was completed in an antecolic position, with a long limb Braun anastomosis, to prevent delayed gastric emptying.Visceral adipose tissue complicates the procedure in terms of identification of anatomical structures and haemostasis management. The patient tolerated the procedure well, with uneventful post-operative course. He was discharged in good health on the 8th post-operative day. Discussion Obesity is a well-known risk factor for complications following major surgeries, including Whipple procedure. The number of obese patients is increasing and specialists should take in consideration the technical aspects and complications following surgical procedures in this group. Most common complications include: longer hospital stay, delayed wound closure and infection, higher tendency for haemorrhage and increased rate for anastomotic fistula. Conclusion Whipple procedure can be successfully completed in overweight patients. However, care must be taken to mitigate the well evidenced risks of higher intraoperative blood loss, delayed hospital stay, wound complications and pancreatic fistula. Several studies establish a relationship between higher BMI and complications following Whipple procedure, but this parameter alone (high BMI) should not be an exclusion criterion.