Pancreatic Surgery

The pancreas is an organ located deep in the abdominal cavity, the function of which is to produce both endocrine (eg. insulin) and exocrine (eg. Amylase and lipase) substances. These substances help to control the blood sugar level and digest food. On occasion part of the pancreas needs to be removed and there are four main procedures that can be performed to achieve this. In general these procedures are performed via open surgery however some of these procedures may be performed via laparoscopic (keyhole) or robotic surgery.

This is also known as a pancreaticoduodenectomy and is named after Dr Allen Whipple who helped pioneer this surgery. During this procedure the head of the pancreas, the duodenum, part of the stomach and small bowel as well as the gall bladder and bile duct are removed. The remaining bile duct, pancreas and stomach are then reconnected to allow for appropriate drainage of the pancreas and liver.

In this procedure the last part of the pancreas is removed +/- the spleen. This is normally performed for tumours or cysts in the body or tail of the pancreas. The spleen is also removed if there is concern the tumour may be malignant and appropriate clearance is required.

In general this procedure is performed for lesions that are thought to be at very low potential for invasive malignancy. The benefit of this procedure is that more pancreatic tissue is retained to help with blood sugar control and digestion. The potential down side of this procedure is that it tends to have a higher complication rate when compared with a distal pancreatectomy.

This procedure is rarely performed however on occasions when a tumour extends across a large area of the pancreas the whole organ may need to be removed. During the procedure the entire pancreas, gallbladder, common bile duct, spleen and parts of the stomach and small bowel are removed. The bile duct and stomach are then reconnected to allow for drainage of the liver and stomach. As the whole pancreas is removed the patient is reliant on insulin to control their blood sugar and enzyme supplements (Creon) to help digest food.

ncreatic surgery is technically demanding and the complication rates are higher than many other abdominal operations. Potential complications include bleeding, wound and lung infections and clots in the legs (DVT) or lungs (PE). As multiple anastomoses (joins between the pancreas, bile duct and bowel) are required this increases the complexity of the surgery. Even with excellent surgical technique these joins may leak and this can cause problems in the post operative period. The most significant of these leaks is a leak of fluid from the pancreas and this is known as a pancreatic fistula. Delayed gastric emptying may also occur following surgery. Your surgeon will discuss with you in more detail the potential complications of pancreatic surgery.

As the pancreas produces insulin and digestive enzymes patients will often be required to take diabetic medication and/or enzyme supplements following pancreatic surgery.