Surgery catalogue pancreas
30.06.2011 | PDF | 7.49 KB
The pancreas is important for digestion and blood sugar regulation. Ist position is in the upper abdomen behind the stomach and it produces some 1.5 liters of digestive fluid every day. Furthermore, it regulates blood sugar by releasing insulin and glucagon along with some other hormones from the so called endocrine cells of which the beta cells are most important.
Operations are essentially done due to two important diagnostics groups.
We distinguish acute and chronic inflammation (pancreatitis). The acute form is mostly treated by conservative means and an operation is only necessary if the course is very severe or complications occur. The chronic form (mostly caused by excess alcohol intake) there are scarring and stenoses in the duct system. Also stones can form in the ducts. Taken together this can lead to outflow obstruction and recurrent episodes of severe pain attacks. This pain syndrome can be effectively and long-term treated by certain operations.
In this procedure the anterior surface of the pancreatic head is exposed and the scarring tissue is excised until the pancreatic duct and sometimes also the bile duct (which also runs through the pancreatic head) is opened. After removal of the outflow obstruction a small bowel loop is connected to the opening in the pancreatic head. This serves to drain the pancreatic secretions and the pain syndrome subsides in 80% of the cases. This success persists for many years after the surgery and is much more efficient than endoscopic treatment.
Tumors of the pancreas develop from different cell types in this organ. Sometimes there are also benign tumors. Unfortunately, the very malignant pancreatic ductal cancer is most common. But also in this tumor there is more and more hope for cure or at least substantial gain of lifetime by appropriate operations.
Depending of the position of the tumor in the pancreas we distinguish head, body and tail tumors which have to be treated by corresponding resections of the involved part of the gland. Mostly the tumor is located in the head. In this case the pancreatic head along with the duodenum, but with preservation of the entire stomach is the standard procedure. After mobilisation of the duodenum and the pancreatic head the first will be transsected at its beginning and end. The pancreatic neck will then be cut and after careful removal of the supplying vessels from the superior mesenteric artery (so called mesopancreas) the whole specimen can be removed including the duodenum, the pancreatic head and the gallbladder. All neighboring lymph nodes are also being removed since they can serve as filter stations for malignant cells and be the origin of recurrence if left in place. Subsequently, the remaining pancreatic tail, the bile duct and the stomach are connected via a small bowel loop to enable the patient to eat and digest normally.
Potential complications are the failure of healing of the pancreatic anastomosis between pancreatic tail and small bowel, of the bile duct anastomosis and rarely also the stomach anastomosis. The first complication is dangerous because in addition to the infection the digestive action of the juice on tissues around the pancreas. A delayed emptying of the stomach is frequent, but subsides after some days in most cases. Hospitalisation is usually between 8 and 14 days.