Surgery to remove distal bile duct cancer

Some people with early distal bile duct cancer can have an operation to remove it. This is called a whipple's operation.

About surgery to remove distal bile duct cancer

Cancer that starts in bile ducts close to the pancreas is called distal bile duct cancer. Sometimes it is possible to remove all the cancer with an operation.

The surgeon will remove:

  • the bile ducts
  • the gall bladder
  • part of the pancreas
  • the part of the small bowel called the duodenum.

This is a major operation. It is only suitable for people with early-stage distal bile duct cancer. In some people, it may cure the cancer.

Only specialist surgeons who have experience in bile duct and pancreatic surgery will do this type of operation. You will be referred to a specialist centre for it.

It is important to discuss the benefits and risks with your surgeon before deciding to have surgery.

You may have one of the operations described below.

Pylorus-preserving pancreato-duodenectomy (PPPD)

In this operation, the surgeon removes:

  • the head of the pancreas
  • most of the first part of the small bowel (duodenum)
  • the common bile duct
  • the gall bladder
  • the surrounding lymph nodes.

This operation is also called a modified Whipple’s operation.


This is like a pylorus-preserving pancreato-duodenectomy (PPPD) operation. But the surgeon will also remove the lower part of the stomach (the pylorus). It is also called a Whipple’s operation.


The sections in white are the parts removed during a Whipple’s operation.


The surgeon attaches the remaining parts of the stomach, the remaining bile duct, and the tail of the pancreas to the small bowel.

After surgery to the pancreas

Insulin injections

If you have had part of your pancreas removed, your body may struggle to control its blood sugar level. This is because the remaining pancreas may not be making enough insulin. You may need to have insulin injections. This is usually only until the remaining pancreas recovers and starts making insulin again.

Digestive juices

You may need to replace the digestive juices (enzymes) that the pancreas normally makes. This will depend on the type of operation you have had and your ongoing symptoms.

Digestive enzymes help your body break down and absorb fats and protein. If you do not have enough of them, you may have diarrhoea. Your stools (poo) may float, look pale and smell bad. You will also find it difficult to put on weight because you cannot absorb nutrients from your food.

Pancreatic enzyme replacement therapy drugs

You can replace the digestive enzymes by swallowing capsules. You usually take these each time you eat or have a milky drink. Your surgeon, nurse or a dietitian will give you more information about how to take the capsules. You will need to take the capsules for the rest of your life.

These are some commonly used, pancreatic enzyme replacement therapy drugs:

  • Creon®
  • Nutrizym®
  • Pancrease®
  • Pancrax®.

Most replacement enzymes are made from pork. It is also possible to get enzymes made from beef. Vegetarian based enzymes are not available.

The most commonly used supplement is a tablet called Creon®, which is a pork-based enzyme replacement. There is no alternative that is not pork-based.

Creon® has been approved for Jewish patients to use by the Chief Rabbi. Previous rulings by Islamic scholars suggest that Muslim patients may use pork-based medicines if there is no alternative. If you are worried about this, speak to your religious leader.

About our information

  • References

    Below is a sample of the sources used in our bile duct cancer information. If you would like more information about the sources we use, please contact us at

    Valle JW, Borbath I, Khan SA, et al. Biliary cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2016; 27, suppl 5, v28-v37. Available from (accessed October 2019).

    Rizvi S, Khan A, Hallemeier C, et al. Cholangiocarcinoma - evolving concepts and therapeutic strategies. Clinical Oncology, 2018; 15, 2, 95-111. Available from (accessed October 2019). 

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Dr Paul Ross, Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

Date reviewed

Reviewed: 01 June 2020
Next review: 01 June 2023

This content is currently being reviewed. New information will be coming soon.

Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

Our cancer information meets the PIF TICK quality mark.

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