SURGICAL TECHNIQUES FOR PANCREAS PRESERVATION
The pancreas plays an important role in the digestion of food and in regulation of blood sugar. Loss of pancreatic tissue after surgical removal increases the risks for the development of diabetes mellitus and mal-absorption of food.
Preservation of pancreatic tissue is an important goal during surgery for pancreatic and biliary diseases to reduce the risks of loss of pancreatic tissue. During the Whipple operation, organs that play a vital role in digestive function are often removed. The organs removed include part of the pancreas and bile duct, and all of the duodenum. The duodenum appears to play an important role in regulating the motility of the stomach and the upper gastrointestinal tract. It is thought that partial or complete loss of the duodenum is responsible for the delay in emptying of the stomach that often occurs after the Whipple operation.
For malignant tumors affecting the duodenum, head of pancreas, and the distal (bottom end) of the bile duct, the Whipple operation is the standard of care and the procedure of choice. The Whipple operation is also frequently performed for benign (non-cancerous) disorders that affect the bottom end of the bile duct, duodenum, or head of pancreas. While in some patients the extent or nature of disease may require a Whipple operation, alternate procedures that preserve some of the organs removed during the standard whipple operation may be an option in other patients.
An important emphasis at the USC Center for Pancreatic and Biliary diseases is the the use of operative procedures that emphasize organ preservation as an alternative to the Whipple procedure in selective patients with non-cancerous disorders affecting the head of the pancreas, the bottom end of the bile duct, or the duodenum.
The procedures we offer as an alternative to the Whipple operation or massive pancreas removal include:
Duodenum preserving pancreatic head resection:
This procedure is offered primarily to patients with chronic pancreatitis. This procedure may also be offered to some patients with benign (non-cancerous) disorders of the head of the pancreas such as cystic neoplasms or small islet cell tumors who would otherwise require a Whipple operation. In this procedure the head of the pancreas is removed while we preserve the duodenum (the first part of the intestine) and the bile duct that are usually removed in a Whipple operation. Patients with this surgical procedure have rapid return of the bowel function and less gastrointestinal type of complications that are often found in patients requiring a Whipple operation. USC is one of the very few centers in the United States that offer this surgical procedure
This procedure is indicated for patients who have low-grade malignant or benign tumors in the neck (in the middle of the pancreas). Removal of tumors in this area often require removing a large portion of the normal pancreas by surgical procedures such as either an extended Whipple operation or a subtotal pancreatectomy (removal of 80% of the pancreas).
We offer a highly specialized surgical procedure that removes only the tumorous portion of the neck of the pancreas. We therefore preserve the head of the pancreas avoiding the Whipple operation and also the body and tail of the pancreas.
This procedure is indicated for patients with low-grade malignancy or benign disorders of the tail of the pancreas. The spleen is often removed with a standard distal pancreatectomy, however, in patients with low-grade malignancy or benign disorders of the tail of the pancreas there is often no indication for a splenectomy. We offer a procedure that would remove only the pancreas while preserving the spleen.
Enucleation of pancreatic islet cell tumors
Many functional pancreatic islet tumors such as insulinoma and gastrinoma are small tumors usually less than 1 to 2cm. Furthermore the tumors are often on the surface of the pancreas. The tumors have a lining around them that separates them from the pancreas.
An operation called enucleation is often performed for these tumors. In this operation the tumor is shelled out from the pancreas without removing any pancreatic tissue. We have developed a laparoscopic technique for this operation. Laparoscopic enucleation of a pancreatic islet cell tumor is allows rapid recovery, early discharge from hospital and early return to work.
Wide resection of Ampulla Vater
This procedure is offered to patients with ampullary polyps or other benign disorders of the ampulla . Patients usually present with pancreatitis or jaundice. The Whipple operation is the usually offered for these benign conditions. We prefer local resection of the ampulla vater for villous adenomas since the pancreas and duodenum are preserved. We widely remove the ampulla and then re-implant the cut ends of the bile duct and the pancreatic duct into the duodenum.
Isolated resection of the third and fourth portion of the duodenum:This procedure is an option for patients with tumors in the third and fourth portions of the duodenum. This procedure is performed to avoid a Whipple operation. In this surgical procedure only the third and the fourth portion of the duodenum is removed and the cut end of the intestine are then sutured together.
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