SURGERY FOR PANCREATIC DISEASES

Summary

The pancreas a long, flat gland that sits tucked behind the stomach in the upper abdomen. It plays a role in the digestive and endocrine system and is an important organ. Surgery for pancreatic conditions addresses either tumours of the pancreas (both malignant and benign) or as a treatment for acute or chronic pancreatitis. Acute pancreatitis is a sudden inflammation of the pancreas that lasts for a short time while chronic pancreatitis is more long-lasting and usually occurs due to damage done by heavy alcohol use.

Pancreatitis is inflammation in the pancreas due to damage done by the digestive enzymes becoming active before they leave the pancreas and enter the small intestine. This condition of the pancreas causes abdominal pain, swelling, fever, nausea and vomiting.

While mild pancreatitis may go away without treatment, severe cases can be life-threatening leading to complications such as malnutrition due to malabsorption of food, the development of pseudocyst, infection, kidney failure, breathing problems and diabetes. Depending on the type of pancreatic disease, surgery may be done to remove a gallstone in the pancreatic duct, to drain a pancreatic pseudocyst or to remove the tumour or diseased parts of the pancreas.

Reasons for pancreas surgery

  • Diagnosis and management of pancreatic diseases
  • As treatment for acute and chronic pancreatitis
  • Treatment of benign pancreatic cysts (distal pancreatectomy)
  • Management of pancreatic pseudocysts
  • Removal of a pancreatic tumour (cancer)

Types

1Endoscopic procedures
Sometimes, acute pancreatitis causes gallstones to form, and the pancreatic duct becomes blocked. When this happens, an endoscopic procedure may be needed to remove the blockage alleviating persistent pain.

This is done through an endoscopic retrograde cholangiopancreatography. This procedure is done with sedation to keep you calm. Your surgeon will then insert an endoscope into your mouth and ask you to swallow it. Once in your oesophagus, the endoscope is moved down to the small intestine, adjacent to the pancreas. Once there, a contrast dye is injected for a special kind of x-ray to be done. This dye will then highlight the pancreatic and bile ducts on x-rays.

Your surgeon can then use the endoscope to remove gallstones. For stones in the duct, a balloon catheter is used to retrieve the stones. Sometimes Dr Kavin will need to remove the stones one by one. After the stones have been removed, your surgeon may want to remove the gallbladder to treat pancreatitis. This is known as a cholecystectomy and can be done laparoscopically through small incisions, minimally invasively.
2Pancreatic Resection
When acute pancreatitis has caused severe complications, such as an infection that doesn't respond to antibiotics, surgery may be needed to remove the diseased parts of the pancreas. This surgery is known as resection and can be done laparoscopically. Through a small incision in the abdomen, a laparoscope fitted with a camera can be inserted into the pancreas and used to locate the diseased or infected tissue. This tissue can then be resected to restore normal function of the organ.

Resection of the pancreas may also be done for pancreatic cancer. In this case, surgery may be done in conjunction with other cancer treatments by your oncology team to remove (resect) all of cancer or as much as possible. Since it can be hard to stage pancreatic cancer accurately just using imaging tests, laparoscopic surgery may be done to stage pancreatic cancer, and also remove some or all of the tumour.
3Pancreatic Cyst Surgery
A pancreatic pseudocyst is a fluid-filled sac that usually develops as a complication of acute pancreatitis. Pancreatic cyst surgery sometimes needed to drain a pancreatic pseudocyst. During this procedure, an endoscope is inserted into the mouth while you are sedated. This endoscope is then navigated down to the pancreas, and a connection is made between the cyst and the stomach so that fluid in the cyst can drain into the stomach. Sometimes a pseudocyst may become necrotic; in such cases, the cyst and dead tissue are removed. This is known as a necrosectomy.
4Surgery for Chronic Pancreatitis
Because chronic pancreatitis means that the organ cannot drain properly, surgery may be advised by your doctor to create a new pathway for drainage. This may be done laparoscopically or through traditional open surgery, but Dr Kavin prefers the minimally invasive approach to decrease post-op recovery time and enhance healing.

When done laparoscopically small puncture-like incisions are made into the abdomen. The laparoscope, which is a thin tube fitted with a camera, is inserted so that he may view the pancreas from the inside. A new duct or passageway may be created and attached to directly to the small intestine, or the existing connection between the pancreas and small intestine may be widened to treat pancreatitis and allow drainage from the pancreas. Any diseased or dead tissue may also be removed at the same time.

Recovery

After an endoscopic retrograde cholangiopancreatography, you may need to remain in the hospital for a few hours until the sedation has worn off. If your gallbladder was removed or the pancreas was resected, you would have been put under general anaesthesia and would thus need to stay for observation for a few days. You may feel bloated or nauseous when you wake up, but this should go away in a few hours of surgery.

Hospital

Operating from the new state-of-the-art, multi-disciplinary facility equipped with only the most advanced medical technology,

Equipment

As one of only two such robots in the Western Cape, Dr Kavin operates from a hospital boasting Robotic Surgery capabilities,

Technique

As a surgeon with adept skill in minimally invasive techniques, Dr Kavin opts for laparoscopic keyhole surgery whenever possible.

Expertise

Dr Bruce Kavin is a General Surgeon with particular expertise in Endocrine, Colorectal and Gastrointestinal Surgery and Surgical Oncology.

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