Total pancreatectomy is an operation to remove the entire pancreas, along with the duodenum, a portion of the bile duct and the gallbladder. This operation also removes a portion of the stomach. After removal of these structures, bile duct and the stomach is then stitched back into the intestine to reconstitute the continuity of the digestive tract.
There is an alternative form of total pancreatectomy is called the Pylorus-Preserving Total Pancreatectomy where the entire stomach is preserved and not removed.
This is a very complex operation. It is only reserved for very selected diseases affecting the pancreas. One good example is a form of cystic tumour of the pancreas called main-duct intraductal papillary mucinous tumour.
Because the entire pancreas is removed, the patient will have no more insulin production, and hence will develop diabetes. The patient will then need insulin injection for the rest of his life. The patient will also need to take medications to assist in the digestion of food.
This operation is performed under general anaesthesia. In addition, the anaesthetist may place an epidural catheter for epidural analgesia. This provides excellent pain relief following the surgical operation.
General information about the total pancreatectomy
Your surgeon will assess your general health status. Blood tests, chest X-ray and electro-cardiogram (ECG) may be done if needed. The purpose of these tests is to ensure that you are healthy and fit enough to proceed with the operation under general anaesthesia.
You may be admitted one day before the operation. However, for selected patients, based on their general conditions, they need just come to the hospital on the day of their operation.
Just remember that you cannot eat or drink anything for 6 hours before the operation.
Your anaesthetist will put you to sleep first before we start. You will have a catheter placed into your bladder to drain the urine. A tube will also be placed through one of your nostril into the stomach to empty the stomach.
The operation is broadly divided into 2 phases:
Phase 1 - Phase of resection.
Resection or the surgical removal of the diseased tissues involved the surgeon dissecting out and removing the tissues as mentioned above. Depending on the unique situation, the spleen may also be removed.
If there is a plan to remove the spleen, then your doctor will boost your immune system before the operation by giving you some vaccinations:
- Pneumococcal vaccine
- Meningococcal vaccine
- Haemophilus influenza vaccine
Phase 2 – Phase of reconstruction.
During this phase, the surgeon will re-establish the digestive tract by suturing the small intestine to the ends of the bile duct and stomach. The point where the surgeon surgically joined two structures together is called anastomosis.
There are 2 anastomoses to construct:
a. Hepatico-enteric anastomosis: where the bile duct is stitched to the intestine
b. Gastro-enteric: where the stomach is stitched to the intestine
Depending on the condition, the entire operation may last from 6 hours to 10 hours.
If the tumour is stuck to major blood vessels, like the portal vein, and there is a need to remove the vein as well, we will activate Dr Lee, our own Vascular Surgeon, to perform the vascular reconstruction.
The patient will be nursed in the High Dependency ward or even the ICU for one or two days.
The patient will have a nasogastric tube and a urine catheter. In addition, there will be one to two surgical tubes placed into the abdomen to remove any residual fluid or blood. The patient will not be allowed to eat for a couple of days. Intravenous fluid will be given to the patient for hydration as well as nutrition.
You are encouraged to be as active as possible. Whilst in bed, you may turn any way that is comfortable. Do frequent calf and leg exercises by pointing your toes back towards your knee and then pointing them towards the foot of the bed. Repeat this 10 times every hour if possible. This exercise prevents deep vein thrombosis. You will need to cough and do deep breathing exercises. This will reduce your risk of getting a chest infection.
The average length of stay following a total pancreatectomy procedure is 10 to 14 days. However the length of stay may vary in individuals. If there are any complications, the length of stay will be prolonged. During the convalescence period, an endocrinologist will come and help manage the diabetes.
Please follow our link to our page on Complications of pancreatic surgery.
An appointment date will be given to you to return for a follow up consultation, usually in about a week.
Please contact your Nexus Surgical surgeon at our 24-hr hotline (+65 6333 5550) if you experience the following:
- Fever more than 38oC
- Severe pain and redness at the wound site
- Discharge from the incisions such as pus and excessive bleeding
- Jaundice (yellowing of skin)
- Severe abdominal pain and bloating