Surgery on the pancreas is performed most commonly for pancreatic cancer and for pancreatitis where this is caused by gallstones.
Pancreatitis
The standard treatment for acute pancreatitis caused by gallstones is removal of the gall bladder (laparoscopic cholecystectomy). Cystogastrostomy (internal drainage of pancreatic pseudocyst into stomach) is performed for pseudocyst, which occurs as a complication of acute pancreatitis. Chronic pancreatitis occasionally requires surgical intervention with either pancreatic resection or drainage procedure (Peustow procedure).
Pancreatic tumour
Once a diagnosis of pancreatic cancer is made, the case is discussed at a multi-disciplinary team meeting and the treatment plan is made. If there is no evidence of metastatic disease (no spread of disease into other organs) and the pancreatic cancer is surgically resectable, a pre-operative assessment is made to determine fitness for surgery. If the pancreatic cancer is locally advanced, invading adjacent blood vessels, preoperative chemotherapy (neoadjuvant) can be given to downstage the disease. In cases of metastatic disease, locally advanced disease or unfit for curative resection, operative bypass of endoscopic stent insertion is performed as palliation.
Pancreaticoduodenectomy (also referred to as the Whipple’s procedure) is performed where the cancer is located at the head of the pancreas (the part nearest the duodenum), and involves removal of the head of the pancreas, the duodenum, the gallbladder, the distal stomach and the bile duct. After this step, the bile duct, stomach and pancreatic duct are reconnected to the small bowel. In cases where the tumour is attached to portal vein/superior mesenteric vein, a segment of vein is removed en bloc and is reconstructed where appropriate. Pylorus preserving pancreaticoduodenenctomy (PPPD) can also be performed where appropriate.
The second surgical approach is called a 'distal subtotal pancreatectomy', and this is generally the technique used where the cancer is present in the tail or the main body of the pancreas. The left portion of the pancreas is removed and in some cases it is also necessary to remove the spleen. This can be performed laparoscopically where feasible.
Open pancreatic resections are performed through midline laparotomy technique and are major procedures. Whipple’s procedure may take 5-6 hours to perform and requires a 5 -7 days hospital admission.
Pancreatic surgery is a major abdominal surgery with a potential risk of complications, which include;
- Bleeding (10-20% requires blood transfusion)
- Pancreatic leak
- Bile leak
- Intra-abdominal abscess
- Delayed gastric emptying
- Long-term complications of diabetes and exocrine insufficiency requiring pancreatic enzymes
A risk of mortality from pancreatic surgery is approximately 1-2%, depending on extent of surgery and patient’s age and co-morbidities.
Post-operative Care Information
The day after your procedure you will be reviewed by Mr Choi and discuss the results of the surgery. You will be examined and the drain will be removed when appropriate. Patients are encouraged to mobilise from day 1 of their post-operative course.
Discharge from Hospital
Medications will be organised and dispensed prior to your discharge, as well as a postoperative outpatient appointment in Mr Choi's private rooms, usually 2 weeks after your procedure.
Dressings
Dressings will be changed to waterproof dressings prior to your discharge. The dressings should be kept intact for at least 7 days post-operatively, after this you can remove them gently yourself. You can take showers and wash with the dressings on during this period of time. There are usually no sutures to be removed because the surgical wounds are closed with absorbable sutures.
Time off work/school
Most people will be away from work or school for 3-4 week after their pancreas operation.
Driving
You should not drive for at least 2-3 weeks after a major pancreatic operation, especially if taking opioid pain relief such as Endone.
Exercise
Light walking and light exercise can be resumed once you feel comfortable. No heavy lifting (greater than 5 kilograms). Rigorous exercise such as weight training, yoga, sit ups should not be performed during the first 6 weeks post surgery. If you have any specific questions, please do not hesitate to ask Mr Choi.
Increasing pain from your surgery after discharge from hospital
If you have any increasing significant pain after your discharge from hospital, vomiting or high fever, you should seek immediate medical advice, either by contacting Mr Choi through his rooms or directly. Alternatively, you could see your general practitioner or attend the Emergency Department at Epworth Hospital. If you have any specific concerns, please do not hesitate to contact Mr Choi's rooms during business hours on 03 9429 1002 or contact Mr Choi directly through Epworth Hospital on 03 9426 6666.
