A total pancreatectomy is unusual to do and is only done when the disease involves the entire pancreas and no other surgical options are available. The operation involves the removal of entire pancreas, the gall bladder, common bile duct, duodenum (the first portion of the small intestine), a small portion of the jejunum (the second portion of the intestine), the 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 to ensure the best outcomes.
The Surgical Procedure
- General anesthesia is given for the procedure. After anesthesia is initiated an ET (endotracheal) tube will be placed into your airway through your mouth and will be attached to a breathing machine (ventilator). The ET tube will assist your breathing while under general anesthesia. A NG (naso-gastric) 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. (On occasion, your surgeon will visualize disease that was too small to be identified on pre-operative scans which would indicate that surgical treatment is no longer appropriate). If the disease has been found to be unresectable, your surgeon will proceed with the necessary steps to minimize any long term problems that could be caused by the disease.
- The procedure usually takes approximately 4-8 hours, depending upon each patient and the extent of the disease.
Potential Complications of Surgery
In addition to the typical risks and complications associated with abdominal surgery, some specific to a total pancreatectomy include:
- Weight loss - A 10-15 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 - 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. Because your body will no longer have 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.
- Pancreatic enzyme insufficiency - will become a problem 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 - occurs when the stomach takes much longer than usual to empty its contents because of the surgery. This condition often resolves itself in 7-10 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. Some patients may require a transfusion if surgery and blood loss is extensive.
- Hospital stay - on average is 7-14 days, depending upon each person's situation.
- After surgery - you will go to the PACU (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 PCA (Patient Controlled Analgesia) pump, an IV pain medication 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 and/or orally.
- NG tube - will remain in until it is felt that any nausea or vomiting is controlled, typically 2 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 when your surgeon thinks appropriate. You may go home with drainage tubes and 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 begin on clear liquids and advance to regular food as instructed and tolerated.
- TPN (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 SCD (sequential circulating device) on your legs to promote circulation. Heparin injections may also be given SQ (subcutaneously, a small injection under the skin).
- Activity - begins one day after surgery by sitting up in a chair and walking. You may shower 24-48 hours after surgery or as directed by your healthcare provider.
- Vaccines - are recommended for all patients who undergo a splenectomy. 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 6-8 weeks after surgery. You can plan on resuming normal activities around 6 weeks post-operatively, but this can vary among patients. Please be patient with yourself, you have just had extensive surgery.
Call Your Health Care Provider If
- 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 health care team can ensure your best outcome.