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Pancreatic Surgery


The pancreas is located centrally in the abdomen and has a wet, spongy texture making it challenging for most surgeons to subjugate. The organ is prone to bleeding due to its lack of encapsulation or covering that makes it susceptible to injury with the slightest degree of rough handling. Suspicious lesions are assessed prior to the procedure with CT scan or MRI scan or in certain situations with endoscopic ultrasound to take fine needle biopsies from the tumor. Diagnostic laparoscopies are specially performed on patients with a diagnosis of pancreatic cancer.

Types And Techniques

Laparoscopic distal pancreatectomy The procedure is predominantly done for cystic and endocrine tumours of the pancreas. Associated with low-grade malignancy, the procedure requires 4 or 5 small wounds in the abdomen, through which the tail of pancreas is mobilized. The specimen is extracted through 4 cm wound in the lower abdomen. This surgery requires specialized instruments like harmonic scalpel and laparoscopic staplers.

Laparoscopic central pancreatectomy This surgery is usually done to treat small tumors in the neck or body of the pancreas. The part of body and tail of the pancreas are preserved with a localized resection of the tumour. Pancreatic islet tumours (e.g.,.Insulinomaetc) are very small about 1 cm to 2 cm or even lesser. A lining around the tumour separates them from the pancreas. A procedure called laparoscopic enucleation of islet tumours is conducted to shell the tumours out of the pancreas.

Whipple procedure Also known as the pancreaticoduodenectomy, the standard Whipple procedure is done to remove the head of the pancreas. Along with it part of the duodenum, a portion of the upper small intestine, a part of the stomach, pancreatic lymph nodes and part of the bile duct are also resected. In the pylorus-preserving Whipple procedure, the pylorus is left intact with the other parts being removed.

Laparoscopic surgery for pancreatitis Complications that develop in patients due to acute pancreatitis such as pancreatic necrosis, abscesses and infections are treated with laparoscopic surgery.

Laparoscopic procedure for pancreatic pseudocysts Some localized fluid collections leak out of the pancreatic duct during an attack of pancreatitis. In some patients, this might not resolve completely and may get localized in the abdominal cavity. This results in the formation of pseudocysts that cause obstruction, pain, inability to tolerate diet and nausea. The laparoscopic procedure drains the cyst into the small intestine or the stomach.

Lateral Pancreaticojejunostomy procedure Patients develop severe pain due to chronic pancreatitis, a condition in which patients develop large stones in the pancreatic duct and parenchyma. Inflammation and stones block the pancreatic duct leading to severe pain.In this operation, the pancreatic duct is opened in its entire length, stones are removed and the duct is stitched into the intestine. Pancreatic secretions are thus drained.

I am a specialist who is extremely familiar with the handling techniques of the pancreas. As a technically demanding surgery, the procedure involves lengthy operating times, which can be performed only by expert surgeons. The laparoscopic central pancreatectomy is an extremely complex and delicate procedure. I am one of the few doctors in the country who can perform the surgery.

Authored by Dr. Deepak Varma, MBBS, MS (General Surgery)

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