Whipple’s Procedure Cost in India: Quality Care at Affordable Prices

Whipple procedure in India

In Whipple surgery, the following is removed:

• The pancreas is a gland composed of two parts, the head of which (where the majority of pancreatic cancers arise) is referred to as the head of the pancreas.
• The duodenum (proximal part of the small intestine)
• The gallbladder
• Part of the bile duct
• In some cases, some of the stomach and the lymph nodes that are near it.

Once the organs have been removed, the surgeon reconnects the remaining organs so that the digestive process can proceed - this involves the reconnecting of the stomach, pancreas and bile duct to the small intestine.

Types of Whipple Procedures

Classic Whipple (Standard Pancreaticoduodenectomy)

• Removes away a fragment of the stomach and its other organs.

Pylorus-Preserving Whipple

• Holds the stomach together keeping the pylorus (valve to passage food into the small intestine).
• Helps have a more normal digestion after surgery.

Total Pancreatectomy (in a few instances)

• Removes the whole pancreas which causes insulin dependence (diabetes) and lifelong enzyme replacement therapy.

Indications

Whipple procedure is mainly applied in case of:

• Pancreatic cancer of the head (adenocarcinoma).
• Ampullary cancer
• Distal bile duct cancer
• Duodenal cancer
• Pancreatic neuroendocrine tumors (in a few cases)
• Chronic pancreatitis (as a last resort, in case of failure of other treatment methods)

Factors Affecting Whipple surgery cost in India

Determinants of the cost of Whipple procedure (pancreaticoduodenectomy) in India:

Surgical type -open/ laparoscopic/ robotic

• Robot and minimally-invasive systems demand costly equipment, special consumables and increase OT-time or specialised personnel; many hospitals place an extra charge of robot use or robot consumable charge.

Type and reputation of hospital 

• The cost of OR time, ICU, surgeon/anaesthetist fees and room at premium private hospitals in metros is higher; the government hospitals are generally cheaper, but there is variation in their availability/wait times.

Surgical team and surgeon charges / experience of surgeon

• Multidisciplinary teams (HPB surgeons, specialised anaesthesia, trained ICU staff) with high volume pancreatic surgeons may attract higher professional charges, and may have lower complication rates, which may in turn lower overall cost across the entire admission.

Hospitalization and ICU utilization

• The ICU and the ward charges are money-consuming every day; complications (pancreatic fistula, infection, re- operation) extend the duration of stay and add interventions and imaging.

Re-intervention and complications

• Abscess, bleeding, fistula, drains, antibiotics, re-operation (possibly), radiologic drainage, and extended stay are complications, and this is one of the biggest unknown cost drivers.

Pre-op investigation, staging and optimisation

• CT/MRI/PET, endoscopic ultrasound, biopsy, cardiac/respiratory clearance and optimisation of comorbidities are billed individually pre-admission.

Consumables, grafts, drains and disposables

• There are staplers, drain, biologic sealants or specialised anastomosis devices, and robotic instruments (disposable arms/ports), which are billed separately. Another additional expense is robotic consumables.

Room type / accommodation options

• Single room vs shared ward vs suite — large variation in price per-day.

City / state place of residence

• Big cities (Delhi, Mumbai, Bangalore, Chennai, Hyderabad) are more expensive than smaller cities because they require more operation and specialists.

Follow-up (chemotherapy / radiation) and adjuvant therapy

• A significant extra cost and impacting the cost of overall treatment is oncologic post-surgical (adjuvant chemo, such as FOLFIRINOX or gemcitabine regimens) treatment, typically billed after surgical care.

Patient (age, comorbidities, nutrition) factors

• More monitoring, optimisation, potential prehab, and more likely to experience complications are required in sicker patients, increasing cost.

Best hospital for Whipple procedure in India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Pancreatic cancer Whipple surgery in India

Whipple procedure or pancreaticoduodenectomy is a complicated surgery performed to cure head pancreatic cancer (the larger part of the pancreas that is close to the duodenum). It may also be applied in some benign or precancerous pancreatic diseases and other cancers around the pancreas (such as bile duct or duodenal cancer).

Preoperative Evaluation

Preoperative patients experience:

• CT scan / MRI / PET scan - to determine the location and dissemination of the tumor.
• Endoscopic ultrasound (EUS) - to assess the size of the tumor, and involvement of the vascularity.
• Biopsy – to confirm diagnosis
• Blood tests- liver functionality test and tumor markers such as CA 19-9.
• In case the tumor has invaded the main blood vessels or other remotely located organs, the Whipple procedure is not carried out.

Surgical Procedures

• Duration: 6–10 hours
• Anaesthesia: General
• Hospital Stay: 7–14 days (varies)

Steps:

• Excision of affected organs (head of the pancreas, duodenum, etc.).

Reconstruction — connecting:

• Small intestine to the pancreas (pancreaticojejunostomy)
• Small intestinal (hepaticojejunostomy) bile duct.
• Small intestine to the stomach (gastrojejunostomy)
• Insertion of drains to avoid fluid buildup.

Postoperative Recovery

• ICU observation first 121 days.
• Staged reintroduction of oral food in a few days.
• Pain management through the use of epidural or IV drugs.
• Pancreatic enzyme supplements can be required to digest.
• Blood sugar (transient or persistent risk of diabetes)

Whipple surgery success rate in India

The success rate of Whipple surgery is approximately 80%–90% in experienced centers.

Top surgeons for Whipple procedure in India

• Dr. Giriraj Bora
• Dr. Adarsh Choudhary
• Dr. Vikas Singhal
• Dr. Amanjeet Singh
• Dr. Ajay Kumar Kriplani
• Dr. Subhash Gupta

Factors Affecting Affordable Whipple procedure in India

These are some of the primary aspects that influence the affordability of the Whipple procedure in India and its impact is discussed:

Hospital Type & Reputation

• The more expensive hospitals are the privates with premium facilities, with NABH / JCI accreditation or the high-end infrastructure. The smaller private hospitals tend to be less expensive than the public or government hospitals. 

City / Location

• Metro cities (Delhi, Mumbai, Bangalore, Chennai, Hyderabad etc.) are costlier as they are more expensive in terms of real estate, operator charges, labour expenses. In small towns/ cities the process can be far cheaper. 

Surgeon Experience & Skill

• Very experienced pancreatic surgeons (in particular Whipple) will be more expensive than the inexperienced ones. Special or super-specialist teams are also cost adders. 

Surgical Technique /Complexity

• It is also differentiated: open, laparoscopic, robotic-assisted. Robotic / minimally invasive methods are more expensive in terms of equipment, higher technology and consumables. Complexity is also raised by factors such as anatomy, location of tumours or co-morbidities that complicate surgery. 

Health / Comorbidity of patient

• In case the patient has other health problems (heart, lungs, diabetes etc.), late-stage disease, previous interventions, it might lead to an increase in tests, monitoring, ICU stay, more medications, thereby increasing cost. 

Pre-operative Workup / Diagnostics

• Imaging (CT, MRI), endoscopy, blood tests, cancer staging, perhaps biopsies etc. are all costs accrued. Further detailed pre-surgical planning is more expensive. 

Length of Hospital Stay/ ICU stay

Prolonged hospital (ICU, in particular) stay, increased number of days of observing or treating complications, are costly. 

Room Type / Amenities

• Patient chooses a general ward, shared room, semi- private, private deluxe etc. More luxury rooms are more expensive. 

Rehabilitation and follow up/Post operating care

• Following surgery, it includes costs of medicines, nutritional assistance, physiotherapy, enzyme supplements, and possibly additional treatment (chemotherapy, radiation) based on the pathology. As well as imaging/testing follow up. 

Available Technology / Infrastructure

• Advanced OT equipment, robotics, high-end imaging, well-equipped ICU etc., are all more expensive. Better infrastructure will result in higher fixed cost in hospitals.

Whipples procedure treatment in India with GetWellGo

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