PANCREATIC SURGERY

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Surgery on the pancreas is performed for a wide variety of clinical problems and this includes Acute Pancreatitis and its complications – Pseudocyst, Pancreatic Necrosis Chronic Pancreatitis Pancreatic Cancer Benign tumours of the pancreas – Insulinoma , Glucaganoma …

Acute Pancreatitis and its complications

Acute pancreatitis is a sudden inflammation of the pancreas due to a variety of causes commonest of which is alcohol intake and gall bladder calculus. The pancreas swells up due to fluid accumulation within its substance. Fatty tissue in and around the areas gets destroyed and saponified. Pancreatic juice leaks out into the surrounding tissues and causes a severe inflammation and destruction of the pancreas and surrounding tissues, eventually results in accumulation of solid and liquid dead tissue or debris. 

Pseudocyst 

is collection of pancreatic juice and inflammatory fluid in the area of pancreas during an episode of acute pancreatitis. Usually it resolves slowly over 2 months and might cause symptoms like vomiting, jaundice or fever if it doesn’t resolve. It is at this stage when surgery may be required to deal with the pseudocyst. The cyst can be drained into either the stomach or small intestine depending on the location of the cyst. The procedure conventionally was done through open surgery. Today this is done by laparoscopy in most tertiary centers in gastrointestinal surgery, which makes helps in faster recovery. Pancreatic necrosis

is presence of dead tissue in and around the pancreas, and this causes abdomen pain, loss of appetite, difficulty in tolerating oral food and fever. A surgery will be required to remove the dead tissue 

Laparoscopic necrosectomy

is one such procedure, where all dead tissue is removed or drained out and the space is washed out with fluids. Three or four small cuts are made on your abdomen, the dead tissue is seen and removed carefully. The postoperative care includes short period of tube feeding, along with tubes placed in the abdominal cavity for postoperative cleansing of the abdomen. The recovery is usually smooth and the patient usually is on a normal diet by 1 week after surgery. 

Chronic Pancreatitis

The disease involves long standing and repeated inflammation of the pancreas, as a result of which the gland becomes wood like and contains plenty of stones within the pancreatic duct. These stones block the duct and causes severe abdomen and back pain, and also results in enzyme deficiency and this causes malabsorption.Lateral pancreaticojejunsotomy is a surgical procedure where the surgeon opens the pancreatic duct and removes all the stones and a part of intestine is joined to this pancreatic duct to drain the enzymes directly into the intestines. Sometimes tissues in the head of pancreas are too much inflamed and in such situation, a Whipple’s procedure is done to remove the head of pancreas. 

Pancreatic Cancer 

Pancreas is divided into head, body and tail and pancreatic cancer usually affects the head of pancreas. The symptoms include loss of appetite, jaundice and weight loss. When the disease is potentially curable, the head of pancreas along with surrounding lymph glands, the duodenum and part of bile duct and sometimes a small portion of stomach needs to be removed by the Whipple’s procedure.

The intestine is joined to the pancreas, bile duct and stomach to restore continuity of the gastrointestinal tract. The surgery requires a hospital stay of approximately 10 days. Laparoscopic Whipple’s procedure is performed in centres with very good expertise in Laparoscopic surgery.

Distal pancreatectomy 

Distal pancreatectomy involves removal of the body and /or tail of pancreas. Cancer of pancreas sometimes affects the body or tail of pancreas. Apart from cancer, few benign tumours like insulinoma, and some cystic neoplasms also affect the tail of pancreas. 

Laparoscopic distal pancreatectomyis performed in most centers for diseases of the body and tail. Three or four small incisions are used to visualize the pancreas with the laparoscope and specialized instruments called staples are used to divide the pancreas. The part to be removed is placed in a small plastic bag and removed though a small incision. The patient usually stays in the hospital for 3 – 5 days.  A short stay in the post-anesthesia care unit, an IV tube for hydration, antibiotic and pain medication, and possibly tubes for the stomach and abdominal incisions are typical for post-operation care.Thus pancreatic surgery includes a wide spectrum of procedures for a wide variety of clinical diseases and duration and recovery varies according to the disease and physical condition of the patient.

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