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The surgical operation to remove the pancreas is called pancreatectomy. This is one of the most complex surgical operations.

The most common reason for performing a pancreatectomy is because of a tumour in the pancreas. This tumour may be a:

  • Pancreas cancer
  • Neuroendocrine tumour
  • Cystic tumour of the pancreas

Other reasons for a pancreatectomy include:

  • Severe pancreatitis where part of whole of the pancreas has died (necrotizing pancreatitis)
  • Trauma like road traffic accident which results in pancreatic injury
  • Pancreatic stones

The pancreas is an elongated rather flat structure located deep in the upper part of the abdomen. It lies in front of the spine and great vessels (the aorta and the inferior vena cava or IVC for short), and behind the stomach. It is sandwiched between the 2 main blood vessels supplying blood to our digestive system, and hence it has a rich blood supply.

The pancreas is divided into 3 main parts: a head, a body and a tail. The head is closely related to the duodenum (the first portion of our small intestine), the body points towards the left side of the body, and the tail is closely related to the spleen.

Because of its deep location, tumours are rarely palpable (able to be detected by a doctor from examination of the abdomen.) It also explains why many symptoms of pancreatic cancer often do not appear until the tumour grows large.

The pancreas is a gland which produces chemicals that are important for our bodily functions.   Pancreatectomy1 

It produces hormones, which help our body maintain a state of balance. One of these hormones is insulin, which regulate the sugar level in our blood. Without insulin, a person will become diabetic, and will need insulin injections.

It also produces digestive enzymes. These enzymes then flow into a duct located within the pancreas which drains into the small intestine (the duodenum). These enzymes help in the digestion of food.

Any disease in the pancreas which impairs the production of such enzymes, or which block the pancreatic duct, will affect the digestion of food, especially of oil and fat. The result is that the oil and fat that is eaten will be passed out in the faeces. The person will notice that the stools are clay-like in colour. There may even be a layer of oil floating on the water surface. This is called steatorrhoea.

Another symptom we will ask patients is the presence of jaundice. This is because the lower part of the bile duct lies within the head of the pancreas. In fact, the bile duct empties into the duodenum at the same point the pancreatic duct empties; this area is called the Ampulla of Vater. A tumour in the head of the pancreas will compress and block the bile duct, causing jaundice, and/or the pancreatic duct, causing steatorrhoea.

Types of pancreatic operations:

  • Whipple operation: this is an operation to remove the head of the pancreas. It also removes part of the stomach.
  • Pylorus-preserving pancreatico-duodenectomy (PPPD): this is a form of Whipple’s operation in which the entire stomach is preserved.
  • Distal pancreatectomy: this is an operation which removes part of the body of the pancreas together with the tail of the pancreas. The spleen may or may not be removed as well.
  • Central or Segmental pancreatectomy: this is an operation to remove part of the body of the pancreas.
  • Total Pancreatectomy
  • Enucleation: this operation only removes the tumour, by shelling out the tumour.
  • Transduodenal ampullectomy: this operation removes the Ampulla of Vater.

Our staff surgeon, Dr Ho, was sent by the Singapore Health Ministry to Germany in 2004 to do a one-year clinical fellowship program. The main focus of the program was on the surgical management of pancreatic diseases.

He has in fact written a book chapter describing in detail how to perform each of the above-mentioned operations. The chapter titled “Pancreaticoduodenectomy, Distal Pancreatectomy, Segmental Pancreatectomy, Total Pancreatectomy and Transduodenal Resection of the Papilla of Vater” has been published in Professor L.H.Blumgart’s “Surgery of the Liver, Biliary Tract and Pancreas. 4th Edition.” ISBN-13: 978-1416032564

Every surgical operation will carry some risks. The surgeon will do his or her utmost to prevent such complications. Also important is that the surgical team must know how to recognise and manage the complications should any arise.

Surgical removal of the pancreas or pancreatectomy is a major operation, and carries significant risk of complications and sometimes, even death. Having the proper training, adequate experience, operating in a team, and having the operation in a hospital with all the relevant specialties and facilities to take care of the patient after the operation go a long way in ensuring a good outcome.

For more details about complications of pancreatic surgery, as well as our outcome results for pancreatic operations, please click here.


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