How Surgery Eases the Pain of Childhood Pancreatitis

Autotransplant has high success rate in children

Doctor holding child's hand

Chronic pancreatitis is a painful inflammatory condition that affects children as well as adults. A child who inherits genetic mutations can get this condition at a very early age.

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Fortunately, doctors are better than ever at recognizing this condition in young children. And surgical solutions are available.

One unique surgical option — total pancreatectomy with islet auto-transplant — offers relief to many children.

Matthew Walsh, MD, chair of the general surgery department at Cleveland Clinic’s Digestive Disease Institute — one of just three centers nationwide that offer the surgery — describes how it works, and why it has such a high success rate.

Which children qualify?

This transplant method works best for children with genetic mutations that lead to pancreatitis as opposed to other causes such as alcohol consumption, Dr. Walsh says. These children are often in chronic pain. They may be in and out of the hospital because of pain and digestive issues.

“If you have an adolescent who’s been drinking excessively, and that’s the cause of their pancreatitis, they’re not going to do as well” with this treatment, Dr. Walsh says.

Does it involve removing the pancreas?

Because a genetic mutation is the source of the problem, the only way to solve it is to remove the entire pancreas.

But Dr. Walsh acknowledges removing the pancreas “is a very big deal.” It means a patient loses the enzymes needed for digestion and certain hormones, including insulin.

Taking pills with meals can replace the enzymes needed for digesting food. Yet, the loss of the pancreas also means patients can develop a condition similar to type 1 diabetes.

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Islet cells — tiny clusters of cells that make hormones and insulin — are an important part of the pancreas. So as part of the transplant process, surgeons take the islet cells and transplant them back into the body. That means they can start producing insulin again.

How does the treatment work?

First, surgeons remove the pancreas. Then they use a process to break it apart so that the islet cells are the only things left, Dr. Walsh explains.

The next step is the “autotransplant” part of the procedure. An IV bag full of plasma and islet cells is connected to a portal vein to the liver. As they re-enter the body, the islet blood cells get smaller and smaller until they’re in the tissue of the liver itself. Surgeons use blood thinners to avoid blood clots during this step, too.

“That’s where they grow and live as a collection of cells,” Dr. Walsh says.

The process restores the insulin production a patient’s body needs. But, fortunately, it does not interfere with liver function.

How well does it work?

The procedure is not new. It has been around since the late 1970s, and surgeons have been using it for children for about 20 years.

What’s new is doctors’ ability to identify genetic abnormalities. That makes it easier to diagnose chronic pancreatitis and learn who might benefit from this surgery, Dr. Walsh says.

Kids seem to do better with the procedure than adults. For one thing, they’re less likely to have had complications such as chronic pain syndrome or addiction problems from the narcotics that treat it, Dr. Walsh says.

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Children also have more islet cells than adults. That gives them more tools to produce insulin normally and factors into how well they respond.

Patients can still develop diabetes after they’ve had the procedure. But the autotransplant can make the diabetes more manageable than it would have been without surgery.

About 40 percent of pediatric patients who undergo this procedure end up not needing any insulin treatment. For those who do, “it’s usually not a big amount, somewhere between 10 to 15 units a day,” Dr. Walsh says.

At least several hundred kids have received this procedure to date. Luckily, chronic pancreatitis is not a common disease in children, he adds.

More information

Pancreatic disease treatment guide

 

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