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Pancreatic Surgery Guide For Patients:

What you should know about pancreatic surgery

Your physician has referred you to our surgeons because of their expertise in this field. We maintain continuing communication with your referring physicians and ensure their involvement in your medical management throughout the process.


What is the pancreas?

The pancreas is a digestive gland located in the abdomen, near the stomach, liver and the part of the small intestine called the duodenum. The pancreas secretes hormones that regulate blood glucose levels, and it produces enzymes that aid indigestion.


 Why do you need surgery?

  • Cancer
  • Pancreatic Pseudocysts
  • Pancreatic Cysts
  • Solid Tumors
  • Chronic Pancreatitis

Surgery is the only known cure for pancreatic cancer and is the standard of care. Surgery is only possible if the cancer is localized. If cancer has spread to blood vessels, distant lymph nodes, or other organs, then surgery is usually not indicated.


What is pancreatic cancer?

Pancreatic cancer is the fourth leading cause of cancer deaths. Signs and symptoms can include abdominal pain, anemia, decreased appetite, unintentional weight loss, itching of the skin, fatigue, jaundice or yellowing of the skin and/or eyes, discoloration of stool and urine.


What do I need to do before surgery? (See check list)

Prior to surgery you will need to see your primary care physician and/or your cardiologist to get appropriate medical/cardiac clearance. You may need additional testing to prepare you for surgery.

You will also need to call the Pre-Surgical Testing (PST) department to make an appointment. They may draw your blood and will ensure that all necessary information is completed prior to your surgery.

You should take a multivitamin daily. This can be purchased over-the-counter (OTC) at your local drug store.

You will need to stop taking all blood thinners such as aspirin,Coumadin, and Plavix seven to ten (7-10) days prior to your surgery.

Please discuss this with your primary care physician and/or your cardiologist before stopping any medications.


What to expect during your hospitalization: 

Surgery may take four to six hours.

Most patients will be in the hospital for approximately 9-10 days.

Pain is controlled with intravenous (IV) pain medications, although other options, such as an epidural, are also occasionally used.

Surgical drains may be placed in the abdomen while you are in surgery; most often they are removed prior to going home. In some cases, however, it is necessary for you to go home with a drain in place.

You will be assisted and encouraged to walk the hallways at least four to six times a day.

Nutrition may be supplied intravenously until you are able to eat.

Usually you are able to have ice chips the day after surgery and will be on a clear liquid diet within three to four days after surgery.


You will be ready to go home:
– When your pain is controlled with an oral pain medication
– When bowel function has returned
– When you are able to eat without nausea
– When you are without fever, or other signs of infection


Complications

There are general complications as well as complications specific to pancreatic surgery.

General complications, which are associated with any major surgery, include:  wound infection, blood clots, bleeding, urinary tract infections (UTI), pneumonia, and heart attack.

Complications specific to pancreatic surgery include:  leaking from the various connections made during surgery, infection, delayed gastric emptying, hyperglycemia, malnutrition, jaundice, diarrhea and cancer reoccurrence. Other complications may occur; however, these are the most common related to pancreatic surgery.

Pancreatic leak occurs in approximately 15% of patients. If a leak develops, it may be necessary for you to go home with a drain in place and temporarily remain on intravenous nutrition until the leak resolves.

Infection can occur and is managed with antibiotics.

Delayed gastric emptying is a condition in which the stomach takes too long to empty its contents. Medications that assist in stimulating the stomach to empty are often given.

Diabetes or hyperglycemia may occur as a result of removing a portion of the pancreas; this can be treated with oral medications and/or insulin therapy.


What to expect at home

When you go home you will be able to shower, eat and climb stairs.
No heavy lifting over five pounds.
No driving until seen by the surgeon in follow-up.
Expect to be off work for six to eight weeks.
It is common to feel tired and weak the first several weeks.
It can take approximately eight weeks to return to your baseline functional status.

 

Incision care

You may shower and cleanse your incision with mild soap and water daily, patting it dry.

  • No bath tubs or hot tubs.
  • Do not apply any lotions, perfumes, or colognes to incision.
  • Staples will be removed in the doctor’s office.
  • Look at your incision daily and notify the doctor if there are any signs of infection, such as temperature of 101°F, foul odor or drainage from wound, redness, or swelling.
  • Notify the surgeon if you have nausea, vomiting, lack of bowel movement or inability to eat.

 

Diagnostics

We can use a variety of imaging studies to establish a diagnosis. These techniques include computed tomography (CT scan), endoscopic ultrasound (EUS), magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and percutaneous transhepatic cholangiography and biliary drainage (PTCD).

Computed tomography (CT) scan is the most common and best imaging test for assessing the pancreas. A CT scan visualizes all of the abdominal organs, and is very useful in detecting masses, blockages, and any spread of cancer to nearby organs and lymph nodes. A CT scan of the pancreas may help determine if the mass is localized, has spread, or if there is blood vessel involvement.

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that is used to visualize the bile and pancreatic ducts for narrowing or obstructions. While the patient is sedated, a thin, lighted tube is passed down the throat, through the stomach and into the first portion of the small intestine, called the duodenum. A catheter is then inserted into the bile and pancreatic ducts and dye is injected into the ducts while x-ray pictures are taken. The pictures may show whether there is a narrowing or blockage of the ducts. During an ERCP a stent can be placed into the obstructed duct to keep the duct open and allow the bile to flow.

Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive type of imaging which uses magnetic resonance imaging (MRI) to visualize the biliary and pancreatic ducts. It is less invasive than ERCP, but intervention such as stent placement is not possible.

Percutaneous transhepatic cholangiography and biliary drainage (PTCD) is a procedure performed by a radiologist that allows visualization of the bile ducts. A thin needle is inserted through the skin and through the liver into the bile duct. Dye is then injected and x-ray pictures are taken. If the biliary system is obstructed, a catheter or stent may be placed to relieve the obstruction and allow bile to flow. This catheter may be connected to a collection bag outside of the body.

Endoscopic ultrasound (EUS) is a procedure used to visualize the pancreas. While the patient is sedated, a thin tube is passed down the throat, through the stomach and into the small intestine. The machine uses sound waves to create images of the pancreas.

 

Anatomy before surgery

Distal Pancreatectomy (Open or Laparoscopic)
A distal pancreatectomy is indicated to remove tumors in the body and tail of the pancreas. The procedure can be done as open surgery as well as laparoscopically. We often remove the spleen at the same time. If the spleen is going to be removed, it will be necessary for you to receive vaccinations from your primary care provider prior to surgery.

These vaccinations include: Pneumococcal vaccine, Meningococccal vaccine, and H. Influenzae type B (these can be given 14 days prior to surgery or 14 days after surgery).

 

Pancreaticoduodenectomy

Pancreaticoduodenectomy is the operation performed for neoplasms that are in the head of the pancreas, the duodenum, or the lower part of the common bile duct. It is commonly referred to as the “Whipple procedure". The Whipple procedure involves removal of the head of the pancreas, the duodenum, a portion of the common bile duct, the gallbladder, many lymph nodes and a small portion of the stomach. The pancreas, stomach and the remaining part of the bile duct are then reconnected to a part of the small intestine called the jejunum to ensure flow of bile and enzymes into the intestines.

 

Total Pancreatectomy

Total pancreatectomy is similar to the Whipple procedure except that the entire pancreas is removed. Removal of the entire pancreas can cause pancreatic insufficiency, which can lead to difficulty processing food by the body and inadequate insulin secretion. These can be treated with pancreatic enzyme replacement and insulin injections.

 

Palliative Surgery

Palliative surgery is often done when the tumor is unable to be surgically removed due to invasion into other organs and/or blood vessels. In these cases, other surgical procedures, such as bypass or stent placement, may be done to improve quality of life and relieve symptoms such as jaundice, nausea, vomiting and pain. Your surgeon may also place a feeding tube to help with nutrition.

Additional treatments such as radiation and chemotherapy may be indicated and will be further discussed with your oncologist.

 

Surgical Check List

» Get blood drawn (order has been given to you by your physician).

» CT scan of pancreas to be done at _________________________ ____________________________________________________ . 
» (Remember to take the order form with you to your appointment.) 
» You need to obtain cardiac/medical evaluation before surgery.
» Please see your Primary Care Physician, Dr. ____________________ . 
» Cardiologist, Dr. _________________________________________ . 
» Call the Pre-Surgical Testing (PST) department, 248-849-3089, to make an appointment. 
» If you are not already on a multivitamin, please start taking one daily. 
» Stop taking all blood thinners (aspirin, Plavix, and/or Coumadin) 10 days before your surgery.

 

Resources

♦Hepato-Pancreato-Biliary Nurse Practitioner (248) 849-8905
♦Providence Hospital Pre-Surgical Testing (PST) Department  (248) 849-3089
♦Providence Hospital Social Work and Case Management Department  (248) 849-3113
♦Providence Hospital Outpatient Dietitian  (248) 849-3903
♦Providence Hospital Outpatient Pharmacy  (248) 849-3939
♦Providence Cancer Center  (800) 341-0801
♦Assarian Cancer Center (Novi)  (248) 465-4300
♦St. John Home Care & Home Infusion (800) 248-2298
♦National Cancer Institute’s (NCI) primary web site http://cancer.gov
♦Pancreatic Cancer Action Network www.pancan.org
♦The Lustgarten Foundation for Pancreatic Cancer and Research www.lustgarten.org
♦The National Pancreas Foundation  www.pancreasfoundation.org
 


 


 

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Dr. Michael Jacobs

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