Depending on the part of the pancreas which is removed, doctors refer to this as either pancreatic head resection, pancreatic body resection or pancreatic tail resection. In rare cases, the entire pancreas must be removed (total pancreatectomy). Pancreatic head removal is the most common and at the same time most complicated surgery. This procedure is also known as the Whipple procedure
The pancreas produces digestive juices and the hormone insulin, which is important for sugar metabolism. The digestive juices are carried over the bile ducts into the duodenum. The most common reasons for pancreatic surgery and chronic inflammation of the pancreas and tumours. The tumours are unfortunately often malignant pancreatic cancer, which stems from the pancreas.
Malignant tumours of the pancreas must always be treated surgically. Depending on the location of the tumour, the head, the body or the tail of the pancreas is removed. The entire pancreas must fortunately only be removed in exceptional cases. Sometimes, surgery is also required for pancreatic cysts. Cysts are empty chambers filled with fluid. Pancreatic cysts are treated surgically if they contain malignant parts or when they cause the patient problems. Chronic inflammation must be treated surgically if it hinders the flow of the digestive juices into the duodenum. Sometimes it is sufficient to insert a plastic tube (pancreas stent) into the obstructed pancreatic duct. This procedure can be carried out endoscopically with a duodenoscopy.
What preparations are carried out before the procedure?
Different examinations are carried out to identify pancreatic diseases. Depending on the situation, ultrasound, CT, MRI, duodenoscopy or pancreas biopsy are used.
The patient is usually admitted to hospital on the day before the surgery. All the usual pre-operative assessments are required, such as a blood test, blood pressure measurement and an ECG. Pancreatic surgery is carried out under general anaesthetic and patients must have an empty stomach before the procedure.
How is the operation carried out?
Pancreatic surgery is a complex procedure which should only be carried out in centres which specialise in this type of surgery. Pancreatic tail surgery, pancreatic head surgery and complete pancreas removal are being carried out more often with minimally invasive laparoscopic technology.
However, surgeons still prefer to undertake pancreatic head removal (Whipple procedure), which is also the most frequent type of pancreatic surgery, as an open operation. During this complicated surgery, the duodenum, parts of the bile ducts and the gallbladder are removed in addition to the pancreatic head. In rare cases, a part of the stomach must also be removed. Pancreatic cancer is usually the main reason for this major surgical procedure.
The abdominal wall is usually opened with a transverse incision, and less often with a longitudinal incision. Firstly, the pancreatic head is exposed and checked to see whether the tumour has grown into the surrounding tissue. If an operation is possible, the bile duct, gallbladder, pancreatic head and duodenum are removed one after the other. Then the separator of the small intestine is pulled up and connected with the rest of the pancreas. The stomach is also connected to the small intestine and the remaining bile duct is newly connected with the small intestine. These new connections are known as anastomoses.
What is the success rate of this procedure?
The prognosis after pancreatic surgery depends on the underlying disease. The success rates for benign tumours or chronic inflammation are usually very good.
In the case of pancreatic cancer, the stage of the cancer has a bearing on the healing success. If the tumours are localised, i.e. have not formed any metastases, the surgery can cure the cancer. However, pancreatic cancer is often only discovered in a stage when surgery extends the patient's life but cannot heal them in full any longer.
What are the possible complications and risks of this procedure?
Pancreatic surgery is a comprehensive procedure. The risk of certain complications such as infections, growths or leaky suture joins is considerably higher than for other abdominal surgery. In rare cases, this can result in acute pancreatic infection after the surgery. Pancreatic surgery should only be carried out in centres which specialise in this area to the keep the risk of this dangerous operation as low as possible.
What happens after the operation?
Patients who undergo pancreatic surgery are usually cared for in the ICU for some time after the operation. The patient's food intake is increased step by step. At the beginning over a tube which was inserted into the small intestine during the surgery. The tube can be removed in one to two days. With time, you can eat and drink again normally. However, you should avoid excessively fatty and sweet food. Depending on the magnitude of the operation, digestive enzymes may need to be taken temporarily or on a permanent basis to support digestion. The patient should refrain from drinking any alcohol. He or she can start playing sport or undertake major physical exertion around six weeks after the surgery.
If the entire pancreas is removed, this causes diabetes, which has to be treated with insulin. If only part of the pancreas is removed, every effort is made to retain sufficient pancreatic tissue for the production of insulin. Nevertheless, insulin treatment is also required from time to time here.
After pancreatic surgery, regular follow-up checks are required. If the surgery was due to cancer, it is usually followed by chemotherapy.