This allows for detection of a bile leak via elevated bilirubin in the fluid drained. Pancreatic leak or pancreatic fistula, defined as fluid drained after postoperative day 3 that has an amylase content greater than or equal to 3 times the upper limit of normal, occurs in 5-10% of operations, although changes in the definition of fistula may now include a much larger proportion of patients (upwards of 40%). Recovery after surgery Immediately after surgery, patients are monitored for return of bowel function and appropriate closed-suction drainage of the abdomen. Return of bowel function Ileus, which refers to functional obstruction or aperistalsis of the intestine, is a physiologic response to abdominal surgery, including the Whipple procedure. While post-operative ileus is typically self-limited, prolonged post-operative ileus occurs when patients develop nausea, abdominal distention, pain or intolerance of food by mouth. Various measures are taken in the immediate post-operative period to minimize prolonged post-operative ileus. A nasogastric tube is typically maintained to suction, to drain gastric and intestinal contents. Ambulation is encouraged to stimulate return of bowel function. Use of opioid medications, which interfere with intestinal motility, is limited. History This procedure was originally described by Alessandro Codivilla, an Italian surgeon, in 1898. The first resection for a periampullary cancer was performed by the German surgeon Walther Kausch in 1909 and described by him in 1912. It is often called Whipple's procedure or the Whipple procedure, after the American surgeon Allen Whipple who devised an improved version of the surgery in 1935 while at Columbia-Presbyterian Medical Center in New York and subsequently came up with multiple refinements to his technique. Nomenclature Fingerhut et al. argue that while the terms pancreatoduodenectomy and pancreaticoduodenectomy are often used interchangeably in the medical literature, scrutinizing their etymology yields different definitions for the two terms. As a result, the authors prefer pancreatoduodenectomy over pancreaticoduodenectomy for the name of this procedure, as strictly speaking pancreaticoduodenectomy should refer to the resection of the duodenum and pancreatic duct rather than the pancreas itself. See also List of surgeries by type References External links Toronto Whipple Clinical Pathway Education App - Open access App for patient and caregiver education The Toronto Video Atlas of Liver, Pancreas and Transplant Surgery – Video of Whipple procedure The Toronto Video Atlas of Liver, Pancreas and Transplant Surgery Patient Education Module – Patient and Family Education video for the Whipple procedure " Whipple pancreaticoduodenectomy: a