Tuesday, June 17, 2014

Distal Pancreatectomy – Pancreatic Surgery, when Pancreas Tail and Body are Removed

In a distal pancreatectomy, the tail and body of the pancreas are removed and the head of the pancreas is preserved. Since the spleen is so close to the tail of the pancreas, sometimes the spleen is also removed during the procedure. 

After removal of the pancreas, the cut edge of the pancreas is often sutured to prevent leakage of pancreatic juice from this area. Most common complication of a distal pancreatectomy is leakage of pancreatic juice from the cut edge of the pancreas. If the spleen is removed as well, you will need vaccinations to prevent future bacterial infections due to the loss of your spleen. These vaccinations should take place at least two weeks before surgery. 

Pancreatectomy Types

Different techniques for distal pancreatectomy:

* Open distal pancreatectomy and splenectomy.

In this procedure the body and tail of the pancreas is removed with the spleen. The spleen is removed with the pancreas since the blood supply to the spleen is intimately associated with the pancreas. This procedure is most frequently performed in patients with adenocarcinoma of the pancreas.

* Spleen preserving distal pancreatectomy.

A surgical procedure is available where the spleen is preserved removing only the pancreas. In this procedure, the blood vessels to the spleen that also provide blood supply to the pancreas are delicately separated from the pancreas and preserved and the tail of the pancreas is removed. This surgical procedure is indicated for patients with cystic tumors and islet cell tumors of the pancreas. This procedure is not indicated and should not be performed in patients who have adenocarcinoma of the pancreas.

* Laparoscopic distal pancreatectomy.

The laparoscopic removal of the pancreas is usually offered to patients that have islet cell tumors of the pancreas or cystic tumors in the body or tail of the pancreas. Selected patients with pseudocysts or chronic pancreatitis may also be suitable candidates.

During this procedure, two half inch incisions are made and a laparoscopic hand-access device is utilized to perform the surgery. The hand-access device incision is about 2 to 2.5 inches long.

Hand assisted laparoscopic surgery is a major advancement in laparoscopic surgery and allows the surgeon to place his/her hand into the abdomen during the surgical procedure.

Patient who undergo laparoscopic distal pancreatectomy have less pain, rapid recovery and early discharge from the hospital compared to open distal pancreatectomy. The average hospital stay for this procedure is about two days compared to 4-6 days for open surgery for distal pancreatectomy.

* Robotic distal pancreatectomy.

Robotic distal pancreatectomy is similar to the laparoscopic approach, except that the instruments are not directly controlled by the surgeon, but instead by a special machine that the surgeon controls. The robotic method provides a level of dexterity not possible with traditional laparoscopic instruments and may increase the chances of saving the patient’s spleen.

After the Surgery

You will probably go to the surgical intensive care unit for a day or so after surgery. When you wake up after surgery, you will have many tubes in place. You will also have a blood pressure cuff on your arm and a little sensor on your finger to measure your pulse and the oxygen level in your blood. You will have special devices on your legs to help prevent blood clots. You will be asked to blow into a small plastic device called a spirometer to help with your breathing. This helps prevent problems such as pneumonia.

You may have:

* IV drips for fluids until you are eating and drinking
* Tubes in your neck to measure your blood pressure
* Drains coming out of your abdomen to drain the bile and fluid collecting around the wound site
* A tube down your nose into your stomach to drain it and keep you from feeling sick
* A catheter in your bladder so your urine volume can be measured
* A little tube into your lower back that goes into your spinal fluid called an epidural which is used to administer your pain medications

Any time you have surgery to your digestive system your bowels will often stop working for awhile. Until the bowels resume normal function, you will not be able to eat or drink. During this time, the feeding tube that was placed in your small bowel during surgery will provide your nourishment. You may go home on tube feedings. If so, the hospital will set this up for you at home before discharge. You may also get total parenteral nutrition (TPN) feedings for more nourishment through an IV drip; this is a white liquid that contains proteins, fats and carbohydrates that can be easily absorbed by the body. Your nurse will encourage you to get up to a chair a few days after surgery. This will be a gradual process. You will then begin to take short walks around your room and the hallway. As the tubes and bags start to be removed, this will become easier for you. The staples will be removed from the surgery site before you go home. Steri-strips or white paper bandages will be placed over your incision.

Possible Surgery Complications

Chest infections, such a pneumonia or blood clots, are both common complications after any major surgery. All of these previously discussed operations are considered major surgery, and there are risks associated with them. Make sure you discuss the possible complications with your surgeon, and ask all the questions you need to before surgery.

Some complications that could occur are:

* Internal infection or abscess
* Fluid collection, which may require drainage
* Delayed gastric emptying
* Bleeding
* Fistula, pancreatic or bile leak
* Chest infection (pneumonia)
* Blood clot
* Heart problems
* Although rare, death (<2%)

Sources and Additional Information:

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