Total Pancreatectomy

Total Pancreatectomy

Introduction to Procedure

We know that undergoing any procedure is a scary experience.  We understand the worry and anxiousness that is associated with surgeries and procedures and aim to walk the road to recovery with you every step of the way. We put this information together using the very helpful handbook, ‘Handbook of Surgical Consent” from Rajesh Nair and David J. Holroyd.  We hope that the following information will answer all your questions and help you with the preparation phase for your procedure.

Description of procedure

A total pancreatectomy is a surgical procedure performed to treat chronic pancreatitis when other treatment methods are unsuccessful.

Operative techniques

This is very major surgery. It involves taking out the whole of the pancreas, your duodenum, a small portion of your stomach, the gall bladder and part of your bile duct, the spleen and many of the surrounding lymph nodes. As you will not have any pancreas left after this surgery, you will need lifelong insulin injections to prevent the development of diabetes. Furthermore, you will need enzyme supplementation, which involves taking a tablet before every meal to assist your digestive system to absorb some of the nutrients in the food you eat. Getting over this type of surgery is hard work. It will take time to get back to eating normally.

Additional procedures that may become necessary

When resection of the tumour is not possible

Sometimes it is not possible to remove the cancer, even though your specialist thought resection was possible based on the scans.

This could be because the cancer has grown around the major blood vessels surrounding the pancreas, or because the cancer has spread to the liver. These findings are not always seen by looking at scans and X-rays.

In cases when the surgeon finds it not possible to resect the cancer then a bypass is performed. There are two parts generally to a bypass, which are performed at the same operation. A ‘biliary bypass’ is when the surgeon can cut the bile duct above the blockage and can reconnect it to the intestine. This bypass nearly always means that you will not become jaundiced again.

Sometimes the duodenum can become blocked by the cancer and so to prevent this from happening the surgeon can attach the small bowel directly to the stomach. This allows food you are digesting to pass through the bowel. This ‘gastric bypass’ nearly always means that you will not experience extreme vomiting which is a symptom of the duodenum becoming blocked.

This operation does not offer any chance of a cure but may enable you to live a life with better quality and less symptoms of your cancer.

Serious/frequently occurring risks
  • A complication is something that happens after surgery that makes your recovery more difficult. Chest infections or blood clots are both common complications after any surgery.
  • All these operations are major surgery and involve certain risks.

The most common complications and the percentage of patients who develop them are:

  • Bleeding 5%: You may have bleeding shortly after your operation because a blood vessel tie is leaking or because your blood is not clotting properly. Bleeding in a few days following surgery can occur because there is infection or a leak from your pancreatic join to the intestine. The manner in which the bleeding episode is treated depends on what is causing it.
  • Leak or fistula 10-15%: A ‘fistula’ is an opening. In this case, it means that part of the internal stitching to the digestive system has come apart or broken down. This results in some of the digestive juices being able to get into your abdomen. Drains put in during the operation will be left in until the fistula dries up. The fistula then usually heals on its own. Sometimes surgery is needed to repair the leak or fistula.
  • Infection 25%: Infection can develop because there is blood or tissue fluid collecting internally around the operation site or because there is internal bleeding. If you develop an internal infection, you will be given antibiotics through your drip. Abscesses or any fluid that has collected internally will need to be drained. Draining the abscess is performed usually by putting in a drainage tube. The needle or tube is guided into place with X-ray or ultrasound.
  • Chest infection: Is a common complication of many operations.
It happens because you are not moving around enough, or breathing deeply enough after your surgery. What you would normally cough up stays in your lungs and becomes a focus for infection. You can help prevent this by doing your deep breathing exercises. The physiotherapists and nurses will get you up as soon as possible to help you get moving. You will have had heart tests before your surgery, but these are very big operations and do increase the strain on your heart.
  • Heart Problems: Some people develop heart problems after surgery that weren’t evident before the operation. Complications after surgery can be very serious. They are becoming less common as more of these operations are done in specialist centres.
  • Between 5-9% of people who have this major surgery die directly as a result of complications after their operation.
Blood transfusion necessary
  • It is seldom necessary for blood transfusions during this type of surgery despite its magnitude. When there is blood loss during the surgery, the blood gets suctioned into a bag which is connected to the cell-saver machine. That blood is then filtered and can be given back to you. In this way we can limit the amount of blood transfusions that we may have to give with the added advantage that it is your own blood. It may however still be necessary to give you blood if the blood loss is severe.
  • Please inform your surgeon if you cannot receive blood transfusions due to religious or medical reasons. Please also inform your surgeon if you have had any previous reactions to any prior blood transfusions.
Type of anaesthesia/sedation
  • General anaesthesia.
Follow-up or need for further procedure
  • You will be asked to book a follow-up appointment to come back to see your surgeon when you leave the ward.

COVID-19 Link