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Pancreatectomy
A pancreatectomy is the surgical removal of all or part of the pancreas.
There are several types of pancreatectomy including pancreaticoduodenectomy (Whipple procedure), distal pancreatectomy, segmental pancreatectomy, and total pancreatectomy, the removal of the entire pancreas.
Hospital Stay: 8 days
Duration: 4-12 hrs
Cost Estimate: 9500 USD - 11000 USD
These are indicative prices in Indian Hospitals
Pancreas surgery is used to treat a number of conditions involving the pancreas including:
- Inflammation
- Necrotising pancreatitis
- Severe chronic pancreatitis
- Severe Trauma
- Neoplasms
- Adenocarcinoma of pancreas
- Cystadenoma
- Cystadenocarcinoma
- Islet cell tumors
- Papillary cystic neoplasms
- Lymphoma
- Acinar cell tumors
- Cancer of the ampulla
- Duodenal cancer
- Cancer of the lower portion of the bile duct.
- Severe hyperinsulinemic hypoglycemia.
- A pancreatectomy can be performed through an open surgery technique, in which case one large incision is made, or it can be performed laparoscopically, in which case the surgeon makes four small incisions to insert tube-like surgical instruments.
- The abdomen is filled with gas, usually carbon dioxide, to help the surgeon view the abdominal cavity.
- A camera is inserted through one of the tubes and displays images on a monitor in the operating room.
- Other instruments are placed through the additional tubes. The laparoscopic approach allows the surgeon to work inside the patient’s abdomen without making a large incision.
Partial pancreatectomy – If the pancreatectomy is partial, the surgeon clamps and cuts the blood vessels, and the pancreas is stapled and divided for removal. If the disease affects the splenic artery or vein, the spleen is also removed.
Total pancreatectomy – If the pancreatectomy is total, the surgeon removes the entire pancreas and attached organs. He or she starts by dividing and detaching the end of the stomach. This part of the stomach leads to the small intestine, where the pancreas and bile duct both attach. In the next step, he removes the pancreas along with the connected section of the small intestine. The common bile duct and the gallbladder are also removed. To reconnect the intestinal tract, the stomach and the bile duct are then connected to the small intestine.
During a pancreatectomy procedure, several tubes called drains are also inserted for postoperative care. To prevent tissue fluid from accumulating in the operated site, a temporary drain leading out of the body is inserted, as well as a gastrostomy or g-tube leading out of the stomach in order to help prevent nausea and vomiting. A jejunostomy or j-tube may also be inserted into the small intestine as a pathway for supplementary feeding.
A total pancreatectomy is a surgical procedure performed to treat chronic pancreatitis when other treatment methods are unsuccessful. This procedure involves the removal of the entire pancreas, as well as the gallbladder, common bile duct, and portions of the small intestine and stomach, and most often, the spleen.
Total pancreatectomy can be combined with transplantation of the patient’s own insulin-producing cells in order to keep the patients from becoming diabetic. A total pancreatectomy without this islet cell transplant results in 100% certainty that the patient will need insulin for life.
Common advantages are:
- Less post-operative pain
- Minimal scarring on the abdomen
- May shorten hospital stay and ICU recovery time
- Quicker return to normal activity
- Lesser instances of morbidity
It depends on the type of surgery that is being performed.
- The Whipple procedure is the most common operation that we perform for pancreatic diseases in the head of the pancreas, and it takes between four to eight hours, on average, to complete.
- Alternatively, you may need to have a total pancreatectomy (eight hours) or distal pancreatectomy (four– six hours) depending on the location of your disease process.
- If the operation is taking longer than the average times, please don’t be alarmed. Your surgeon will try to update you during the surgery.
- Epidural catheters are frequently used for pain control. The anesthesiology team will meet and give you the option of an epidural catheter. This is an excellent pain control option.
- Immediately before you are taken from the preoperative area to the operating room, the anesthesiologist will place the catheter in the space just outside of your spinal cord. After surgery, you will have a button that will allow you to control the amount of medication that you receive. The epidural injects anesthetic medication that directly numbs your nerves, particularly those sensory nerves for the area where your incision is located.
- If you choose to not have the epidural catheter placed, then you will be given a narcotic like morphine that is administered into your peripheral veins.
- The advantage of using an epidural catheter is that it minimizes the amount of narcotic that you receive.
- Narcotics can increase the amount of time it takes for your intestines to begin working again after surgery.
- The anesthesiology pain team visits all of the patients with epidural catheters every day.
Most patients have a bladder catheter which is usually left until the epidural pain catheter is removed, between day five and seven after surgery. Also, you will have at least one drainage tube coming from inside your abdomen. This is usually placed next to where your pancreas is reattached to your bowel (Whipple) or transected (distal pancreatectomy). This drain is most often removed before you are discharged from the hospital. Occasionally, if you have a small bile duct, you will have another tube placed in your bile duct that will be taken out two months after surgery.
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