What are the Best Surgery Options for Your Pancreatic Condition?
If you have problems with your pancreas — pancreatic cancer or pancreatitis, for example — surgery may provide some good options for treatment. While there are a variety of pancreatic operations, here is a look at two specific procedures: Advertising Policy Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic … Read More
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The Whipple procedure
One surgery, call the Whipple procedure can be an option for patients with pancreatic cancer or benign, noncancerous conditions in the front portion of the pancreas, says surgeon Jane Wey, MD. The front portion includes the duodenum, distal bile duct or the ampulla, which is the connection between the bile duct, pancreas duct and the intestine.
The procedure is named for Allen Whipple, MD, the surgeon who first performed it in 1935 and is also known as a pancreaticoduodenectomy. The procedure involves removal of the wide part of the pancreas, the gall bladder and sometimes part of the stomach. The surgeon then reconnects the remaining intestine, bile duct and pancreas.
It is a complex operation, Dr. Wey says, and can last upwards of five hours. She emphasizes that if the Whipple procedure is an option for treatment, you should first discuss it in detail with a surgeon who has extensive experience performing the operation.
“If patients are selected well and they have a surgeon who is experienced in doing the surgery and managing post-operative care, the outcomes can be good,” Dr. Wey says.
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At Cleveland Clinic, doctors use minimally invasive robotics for a selective 25 percent of these operations. The number of complications is generally the same as with an open procedure for pancreatic cancer, Dr. Wey says.
Help for complications
As with most types of intestinal surgery, there can be complications, Dr. Wey says. The one most common with the Whipple procedure is pancreas leak, where the connection to the pancreas doesn’t heal properly. The digestive enzyme manufactured by the pancreas often makes it more difficult for those tissues to heal.
Doctors often can treat the leakage with a simple drain tube. However, sometimes they must take a more involved approach. That is another reason why it’s important to choose a hospital or medical center that is comfortable managing the potential complications of a Whipple procedure.
Another complication which may develop is known as gastroparesis. This occurs when the stomach does not empty properly after the operation.
This can be a transient condition or it may take some time to recover. The latter case might require a feeding tube for nutrition and a drain tube in the stomach.
There also is a surgical procedure specifically for patients with chronic pancreatitis that cannot be managed by other treatments. During this procedure, known as a total pancreatectomy, the surgeon removes the entire pancreas and then re-implants the hormone-producing islet cells (also called islets of Langerhans) scattered throughout the pancreas.
After the surgeon removes the pancreas, the islet cells are isolated and then re-infused into the patient’s liver through a catheter. The purpose is to ensure that the body has enough healthy islets to make insulin without a pancreas.
While the Whipple procedure can treat chronic pancreatitis, doctors use it only if the disease is in the front portion of the pancreas.
Signs of pancreatic disease
Some signs of pancreatitis and pancreatic cancer are very similar: abdominal pain, difficulty eating, weight loss, diarrhea and, occasionally, new-onset diabetes.
Many people with pancreatitis experience an initial attack characterized by severe abdominal pain, Dr. Wey says. Blood tests may indicate pancreatitis, often associated with alcohol abuse, gallstones, certain medications, or autoimmune causes.
People with pancreatic cancer, on the other hand, may develop these symptoms gradually over weeks to months.