Pancreas Surgery

The pancreas, located in the abdomen, is responsible for the production of digestive juices and the hormones insulin and glucagon. It is a leaf-shaped organ that is categorised into a head, body and tail region. The normal functions of the pancreas can be greatly affected by cancer and inflammation (pancreatitis) caused by excessive intake of alcohol, genetic factors, autoimmune problems, blockage of the pancreatic or common bile duct, other conditions such as cystic fibrosis and certain medications. Surgery is a common treatment option recommended to treat pancreatic cancer and pancreatitis that cannot be treated with medication.

The surgical treatment options for pancreas disease include:

• Whipple procedure: Also known as pancreaticoduodenectomy, it is performed to treat cancers at the head (wide part) of the pancreas. During the procedure, the head of the pancreas, the gallbladder, duodenum, a part of the bile duct, and sometimes a part of the stomach are removed. The remaining bile duct, intestine, and pancreas are then reconnected so that enzymes and bile can flow back into the intestines.

  Infection, bleeding, diarrhoea, weight loss and diabetes are common surgical complications of this procedure. You will be able to eat small amounts of easily digestible food and may have to take medications to assist digestion.

• Distal pancreatectomy: It is usually performed when the cancer is found in the middle or tapering end of the pancreas. This procedure takes less time and has a shorter period of recovery when compared to the Whipple procedure.

• Total pancreatectomy: A complete resection is opted when the tumour extends across the pancreas. During the procedure, the entire pancreas, the gallbladder, common bile duct, spleen, and parts of the stomach and small intestine are removed. Following the surgery, the patient loses the ability to create enzymes for digestion and insulin for controlling blood glucose level, and would have to take enzymes and insulin supplements for lifelong.

• Drainage procedures: It is performed to open the pancreatic ducts that are blocked due to chronic pancreatic damage. An incision is made from your chest to abdomen, and the pancreas is exposed. The pancreatic duct can be opened from head to tail (Puestow procedure) or transversely at the neck and body (Du Val procedure) and connected to a loop of the small intestine, into which the pancreatic juices drain. The incision is then sutured. Complications associated with this procedure include bleeding and pancreatic fistula (due to leakage).

• Pancreas transplantation: This procedure is primarily indicated for type 1 diabetes. It involves removing your pancreas and replacing it with a healthy pancreas from a donor. The surgery is performed under general anaesthesia. Your surgeon will make an incision in the middle of your abdomen and connect the pancreas and part of the intestine from the donor with your blood vessels. Your pancreas is not removed, but retained to help in digestion. The surgery takes around 3 hours, and is sometimes performed along with kidney transplant, which then takes around 6 hours.