Pancreatic Surgery

Pancreatitis is inflammation in the pancreas. The pancreas is a long, flat gland that sits tucked behind the stomach in the upper abdomen. The pancreas produces enzymes that help digestion and hormones that help regulate the way your body processes sugar (glucose).

Pancreatitis can occur as acute pancreatitis — meaning it appears suddenly and lasts for days. Or pancreatitis can occur as chronic pancreatitis, which describes pancreatitis that occurs over many years.

Mild cases of pancreatitis may go away without treatment, but severe cases can cause life-threatening complications.

Signs and symptoms of pancreatitis may vary, depending on which type you experience.

Acute pancreatitis signs and symptoms include:

• Upper abdominal pain
• Abdominal pain that radiates to your back
• Abdominal pain that feels worse after eating
• Nausea
• Vomiting
• Tenderness when touching the abdomen

Chronic pancreatitis signs and symptoms include:

• Upper abdominal pain
• Indigestion
• Losing weight without trying
• Oily, smelly stools (steatorrhea)

Pancreaticoduodenectomy (Whipple Procedure)

The Whipple Procedure, or pancreaticoduodenectomy, is the most commonly performed surgery to remove tumors in the pancreas. In a standard Whipple procedure, the surgeon removes the head of the pancreas, the gallbladder, part of the duodenum which is the uppermost portion of the small intestine, a small portion of the stomach called the pylorus, and the lymph nodes near the head of the pancreas.

The surgeon then reconnects the remaining pancreas and digestive organs so that pancreatic digestive enzymes, bile, and stomach contents will flow into the small intestine during digestion. In another type of Whipple procedure known as pylorus preserving Whipple, the bottom portion of the stomach, or pylorus, is not removed. In both cases, the surgery usually lasts between 6-10 hours

After a Whipple procedure, the most common complication is delayed gastric emptying, a condition in which the stomach takes too long to empty its contents. Usually, after 7-10 days the stomach begins to work properly. If delayed gastric emptying persists, supplemental feedings by a feeding tube may be started. The condition usually lasts for another 7-10 days, but could last as long as a few weeks.

The most serious potential complication is abdominal infection due to leakage where the pancreas has been connected to the intestine. This occurs in approximately 10% of patients and is usually managed by a combination of draining tubes, antibiotics, and supplemental tube feedings. Patients who have undergone the Whipple procedure may experience long-term effects including digestive difficulties.

Longitudinal Pancreaticojejunostomy (Puestow Procedure)

The Puestow procedure (also known as a Puestow-Gillesby procedure, or a pancreaticojejunostomy) is a surgical technique used in the treatment of chronic pancreatitis. It involves a side-to-side anastomosis of the pancreatic duct and the jejunum.

The operation involves creating a longitudinal incision along the pancreas while the main pancreatic duct is filleted open longitudinally from the head of the organ to its tail. The duct and pancreas are then attached to a loop of the small intestine (pancreaticojejunostomy), which is oversewn to the exposed pancreatic duct in order to allow its drainage. When used in the appropriate setting, pain from chronic pancreatitis can improve.

One advantage of this procedure compared to a Frey's procedure is that pancreatic tissue is preserved, which may be of critical importance in patients with exocrine or endocrine insufficiency from their chronic pancreatitis.