LAPAROSCOPIC SURGERY
FOR PANCREATITIS

Laparoscopic treatment for complications from pancreatitis

At USC we are on the forefront of developing new laparoscopic techniques for the treatment of complications from acute and chronic pancreatitis. Laparoscopic surgery is best suited for patients with benign (non-cancerous) disorders. Complications from pancreatitis are therefore ideally suited for management by laparoscopic surgical techniques.

The use of traditional laparoscopic surgical techniques has been limited for surgical procedures for acute and chronic pancreatitis due to the technical difficulties with advanced laparoscopic surgical procedures on the pancreas.

Recent advances in laparoscopic technologies provide an opportunity for developing new techniques in advance laparoscopic surgery diseases of the pancreas, bile duct and liver. We have adapted these new technologies to develop laparoscopic operations for patients with complications from acute and chronic pancreatitis.

Procedures for acute pancreatitis

The most serious complication of severe pancreatitis is the development of pancreatic necrosis (dead pancreas) that requires removal. Pancreatic abscesses and infections frequently occur in the areas of dead pancreas that require urgent surgery.

We have develop a specialized laparoscopic procedure for removal of pancreatic necrosis and associated infections. This procedure appear to allow quicker healing and more rapid recovery from this dreaded complication.

Pancreatic pseudocysts are localized collections of pancreatic fluid that has leaked out of the pancreatic duct and developed into a local swelling behind the stomach. The pseudocyst may give rise to pain, nausea and blockage of the stomach or the duodenum.

At USC we have developed a laparoscopic procedure for treatment of pancreatic pseudocysts.In the laparoscopic surgical procedure a connection is created between the cyst and an adjacent gastrointestinal organ to which the cyst is adherent to such as the stomach. This connection allows the cyst to drain into the stomach.

Since in many patients the cyst is formed by continuous leakage of pancreatic juice into the cyst the connection allows the pancreatic juices to drain into the intestine through the connection .Patients recover rapidly from this procedure usually discharged home on the second day post-operatively.

Procedures for chronic pancreatitis

Peustow’s operation is offered to patients with severe pain from chronic pancreatitis who have a markedly enlarged pancreatic duct and who have documented abstinence from alcohol abuse.

In this operation the pancreatic duct is open all the way from the head (beginning of the pancreas) to the tail (end) of the pancreas. The small intestine is then brought up to the pancreas and is sutured to the pancreatic duct. The pancreatic juice is therefore drained directly into the small intestine. We perform the Peustow’s procedure both by an open surgical approach and through a laparoscopic approach.

In the laparoscopic Peustow operation, we utilizes small incisions is now preferred at USC for this procedure due to shorter length of stay in the hospital and early recovery from surgery.

Laparoscopic distal pancreatectomy

We offer laparoscopic distal pancreatectomy in which the bottom half or tail of the pancreas is removed to patients that have chronic pancreatitis located only that part pancreas.

Patient who undergo laparoscopic distal pancreatectomy have less pain, rapid recovery and early discharge from the hospital compared to open distal pancreatectomy. Our average hospital stay for this procedure is about two days compared to 4-6 days for open surgery for distal pancreatectomy.

Laparoscopic Whipple surgery

At USC, Dilip Parekh M.D. is developing techniques for a laparoscopic Whipple operation. At present this procedure is performed laparoscopically at USC in selected patients who have ampullary cancer. We do not offer the laparoscopic Whipple operation for pancreatic cancer. The Whipple operation is performed laparoscopically utilizing the laparoscopic hand-access device.

Laparoscopic treatment for pancreatic pseudocysts

Pancreatic pseudocysts are localized collections of pancreatic fluid that has leaked out of the pancreatic duct and developed into a local swelling behind the stomach. The pseudocyst may give rise to pain, nausea and blockage of the stomach or the duodenum.

At USC we have developed a laparoscopic procedure for treatment of pancreatic pseudocysts. In the laparoscopic surgical procedure a connection is created between the cyst and an adjacent gastrointestinal organ to which the cyst is adherent to such as the stomach. This connection allows the cyst to drain into the stomach.

Since in many patients the cyst is formed by continuous leakage of pancreatic juice into the cyst the connection allows the pancreatic juices to drain into the intestine through the connection .Patients recover rapidly from this procedure usually discharged home on the second day post-operatively.

Laparoscopic splenectomy

In this procedure the spleen is removed by laparoscopic techniques. We offer this procedure to patients with small and large spleens. Removal of the spleen is sometime indicated in patients who have a complication of chronic pancreatitis called left sided portal hypertension. In this complication the inflammation from chronic pancreatitis blocks the splenic vein (a blood vessel that drains the blood from the spleen). This causes abnormal blood vessels that grow in the wall of the stomach.

Patients with left sided portal hypertension often present with recurrent episodes of bleeding from these large abnormal blood vessels in the stomach. The hemorrhage can be life threatening. The treatment of choice for this condition is removal of the spleen preferably by laparoscopic techniques.

Contact information: USC Center for Pancreatic and Biliary Diseases
1510 San Pablo Street, Los Angeles, CA
Phone: 323-4425837 dde-mail:PancreasDiseases@surgery.usc.edu
Programs: pancreatic cancer, pancreatitis, laparoscopic surgery, endocrine surgery,
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This web site provides select information about pancreatic and biliary disorders and is updated twice monthly. This information is not intended as a substitute for professional medical consultation with your physician.It is important that you consult with your physician for detailed information about your medical condition and treatment.The center will make every effort to update the site, however, past performance is no guarantee of future medical outcomes.
Copyright © 2002 USC Center for pancreatic and biliary diseases. All rights reserved.