A total pancreatectomy is only done when the disease involves the entire pancreas and no other surgical options are available. The operation involves the removal of the entire pancreas, gallbladder, common bile duct, duodenum (the first portion of the small intestine), a small portion of the jejunum (the second portion of the intestine), pyloric antrum and pylorus (the bottom third of the stomach), lymph nodes near the pancreas, and the spleen.
The procedure requires the skill of highly-trained, specialized surgeons at the Center for Liver and Pancreas Surgery to ensure the best outcomes. This procedure can also be performed robotically.
What Happens During Total Pancreatectomy?
- General anesthesia is given for the procedure. After anesthesia is initiated an endotracheal (ET) tube will be placed into your airway through your mouth and will be attached to a ventilator. The ET tube will assist your breathing while under general anesthesia. A naso-gastric (NG) tube will also be placed through your nose and into your stomach when you are in the operating room to prevent nausea and vomiting.
- The incision used to perform the operation can be horizontal or vertical.
- After the incision is made, your surgeon will inspect the pancreas and surrounding area to ensure that the surgery can still be performed safely.
- The procedure usually takes approximately four to eight hours, depending on the extent of the disease.
What Are the Potential Complications of Total Pancreatectomy?
In addition to the typical risks and complications associated with abdominal surgery, some specific to a total pancreatectomy include:
- Weight loss: A 10 to 15 pound weight loss is common after surgery. You will regain some weight as you recover from surgery with the return of your appetite and increased nutritional intake.
- Diabetes: The onset of diabetes will occur as a result of removing the pancreas. The pancreas is responsible for producing insulin, a hormone which regulates the body's blood sugar level and for maintaining good health. When your body no longer has the ability to produce insulin, you will be required to take insulin by injection and follow a diabetic diet for the remainder of your life. To minimize or prevent the onset of diabetes, some patients may undergo an auto islet transplant [link to page].
- Pancreatic enzyme insufficiency: As a result of the pancreas being removed, pancreatic enzyme replacement therapy will be ordered by your physician to help aid digestion.
- Delayed gastric emptying: The stomach will take much longer than usual to empty its contents because of the surgery. This condition often resolves itself in seven to 10 days as the stomach begins to heal and resume its normal functions. If it does not, your surgeon will discuss the best way to treat this situation.
- Blood loss: Most patients do not require a blood transfusion, but it may be required if blood loss is extensive.
What Happens After the Pancreas Has Been Removed?
- Hospital stay on average is seven to 14 days, depending upon your specific case.
- After surgery you will go to the Post Anesthesia Care Unit immediately after the procedure for careful monitoring. This stay is usually for a few hours. When your surgeon feels you are stable, you will be transferred to a regular surgical floor, but may go to another unit in the hospital if your surgeon feels that you need to be monitored more closely.
- Pain medication is given to each patient using a Patient Controlled Analgesia (PCA) pump, an IV delivery system which allows you to personally control the delivery of pain medication the first few days after surgery. You will then be taken off of the PCA pump and progressed to pain medication by injection or orally.
- The NG tube will remain in until it is felt that any nausea or vomiting is controlled, typically two days.
- Drainage tubes are placed in the abdomen, near the surgical site, during surgery. The drainage tubes will lead out of the body and will drain to small suction devices. This allows for drainage of the fluids that are produced as a result of surgery and the healing process. As healing takes place, the drainage from the surgery will decrease and the tubes will be removed at your surgeon’s direction. In the event you are sent home with drainage tubes, you will be taught how to manage them.
- Insulin will be given on a sliding scale (an individualized dose based on each person's blood sugar level) to regulate your blood sugar and assist in healing.
- Eating may begin once your surgeon feels your digestive system is ready. You will start with clear liquids and advance to regular food as instructed and tolerated. Total parenteral nutrition may be given post-operatively to provide IV nutrition if needed, otherwise you will be given liquids and then advanced to a regular diabetic diet before going home.
- Blood clots are prevented post-operatively by the use of a sequential circulating device on your legs to promote circulation. Heparin injections may also be given subcutaneously via a small injection under the skin.
- Activity begins one day after surgery by sitting up in a chair and walking. You may shower 24 to 48 hours after surgery or as directed by your healthcare provider.
- Vaccines are recommended for all patients who undergo the removal of the spleen. The spleen plays an important role with the immune system and when it is removed you will become more susceptible to certain infections. You may receive vaccines such as pneumovax and H.flu to help fight infections.
- Recovery time is typically six to eight weeks after surgery. Please be patient with yourself, you have just had extensive surgery.
Call Your Healthcare Provider If You Notice:
- Temperature greater than 100.4
- Increased or foul smelling drainage from your incision site
- Increased pain or redness at your incision site
- Pain, nausea, or vomiting that is increased or not controlled by your current medication
- Diarrhea or constipation that is not controlled
- Anything that is of concern to you, as only communication with your healthcare team can ensure your best outcome.
Can Total Pancreatectomy Be Performed Robotically?
We are able to perform total pancreatectomy using an advanced minimally invasive technique called robotic surgery. Your surgeon will control several highly dexterous and precise robotic “hands” to operate through small incisions. Compared to open surgery, this method shortens hospital stays, minimizes scarring, reduces postoperative pain, and speeds recovery.