Pancreaticoduodenectomy
A pancreaticoduodenectomy is a surgical procedure done for treatment of diseases of the distal common bile duct or duodenum, or most commonly cancer of the pancreas. It is commonly named a Whipple procedure, after the first surgeon that employed it in clinical practice.
This operation involves removal of the pancreatic head, the lower part of the common bile duct, the first part of the duodenum, the gallbladder and the lower bit of the stomach.
This is because these organs function together as a unit and share their blood supply. After excision the bowel, pancreas, bile duct and stomach are reconnected to enable normal function post-operatively. It is a difficult operation and usually takes more than 5 hours to complete.
The most common complications are a leak from the area where the pancreas is reconnected to the bowel, or bleeding from one of the cut surfaces or bleed vessels encountered during dissection. Most commonly, these complications are treated conservatively and do not require further intervention, although it may sometimes be necessary to place a drain post-op, or rarely even need to go back to theatre for repair. The risk of dying in the first 30 days after this operation is between 1 and 5%.
Long term effects are common and most commonly include indigestion, bile reflux, abdominal bloating, diarrhoea or the development of diabetes mellitus.
More information about the Whipple procedure can be found here. A helpful guide for patients and relatives about Pancreatic Surgery can be viewed here.
Left Pancreatectomy
Although diseases of the pancreas most commonly affect the head and neck of the organ, similar diseases may occur in the tail and body. These conditions are treated by resection of the left half of the pancreas. Because the pancreas sits on top of, and are intimately related to the blood supply of the spleen, the spleen is usually removed with the pancreatic tail. This is usually of minor consequence but would mean that the patient would need an immunisation to prevent possible future infections.
The most common adverse event associated with this operation is leakage of pancreatic fluid from the cut end of the pancreas. In most cases this is treated by drainage only, although in some instances it may be necessary to return to the operating room for repair.
Normally a patient can expect a length of hospital of between 3 and 7 days.
Additional reading about this surgery, click here.
Surgery for Pancreatitis
Chronic pancreatitis is a disease characterised by inflammation of the pancreas, usually associated with long standing pain, and/or hormonal imbalances. As the disease progresses, the gland itself may change in consistency and the duct of the gland can become obstructed, causing even more pain. Although non-surgical options are available in some cases, patients in whom the anatomy allows is best served by surgical management.
This is aimed at drainage of the obstructed duct, removal of resulting stones and excision of some of the inflamed pancreatic tissues. The open duct is then sutured to a segment of small bowel to ascertain drainage.
The main risks of this operation is related to the joint between the pancreatic duct and bowel, and also at the site where the bowel is reconnected to itself, in addition to the risk of bleeding from the area of dissection. Leakage is usually treated by drainage, although in some cases or when other complications arise it may be necessary to return to the OR for repair.
The usual duration of hospital stay for this procedure is between 5 and 7 days.
Liver Resection
Liver resection or hepatectomy, refers to the surgical excision of some parts of the liver. This may vary from minor resections where only a small part is removed, to more extensive resections where up to 70% of the liver may be removed for treatment of some liver disease (most commonly cancer that has spread to the liver from other organs). This can be done with relative safety as the liver has the capacity to enlarge and partially regenerate after resection. In some cases it may be necessary to perform an additional intervention in order to increase the size of the liver that will be left behind after the operation.
Major hepatectomy is a difficult operation which usually takes more than 4 hours to complete.
The most commonly occurring complications specific to this procedure include bleeding after the operation, bile leakage from the cut surface of the liver, or rarely post hepatectomy liver failure. Bleeding after hepatectomy is usually managed conservatively, although it may sometimes be necessary to control the bleed by other means, even re-operation. Bile leakage is usually managed by drainage of the resulting fluid collection, although it may be necessary in rare cases to correct the problem in theatre.
Liver failure is a serious, but fortunately rare complication of liver resection. This happens most commonly when the remaining liver is inadequate in size, although it may occur in patients with adequately sized livers, where the organ itsself may be damaged due to disease or other agents such as chemotherapy.
After hepatectomy a patient can expect to remain in hospital between 3 and 10 days, depending on the extent of the surgery performed.
More information about Liver Resection can be found here. A helpful guide for patients and relatives can be viewed here.
Liver Ablation
Ablation refers to the destruction of a lesion, usually the liver, by heat or other means. It is commonly performed for cancers that have spread to the liver after originating in other organs. To generate the heat required, microwaves are used, coming from a special needle probe which is inserted into the substance of the tumour. The size of the ablation zone is determined accurately using ultrasound and this allows planning to determine the amount of energy to be used to treat the lesion precisely.
As there is a limit to the amount of heat which can be used, lesions treated by ablation are usually smaller than 3,5 cm in diameter. It is important to also consider the location of the lesion, as heat may be transferred to other nearby structures, which could lead to complications or unwanted effects. Most studies have shown that lesions treated by ablation have the same long-term outcomes as similar lesions treated by surgery. Although it can sometimes be done via the skin, it is often necessary to do an operation for placement of the probe.
The particular risks and benefits of this procedure will be discussed during our consultation, however, the most common complications of this procedure is related to the operating site, such as wound sepsis, bleeding from the puncture site and rarely abscess formation at the ablation site.
For more information about Liver Ablation, click here to refer to a helpful patient guide.
Bile duct repair/bypass
Laparoscopic cholecystectomy is one of the most commonly performed operations worldwide. Although it is a very safe operation, it may sometimes happen that another organ may be damaged or affected by doing this operation, most commonly the main bile duct draining the liver. This can manifest as persistent drainage from a wound catheter, or sometimes as jaundice, even years later.
Bile duct repair is a difficult operation and may need extensive tests and planning to complete.
In rare circumstances one may be able to repair the duct itself if the injury is noted at the time of the first operation. However, it is usually required to do the repair at a later stage when the inflammatory process has subsided. This is most commonly done by performing a bypass procedure where the injured duct is joined to a piece of small bowel, thus enabling the liver to drain into the small bowel as usual. Rarely, it may be necessary to remove a segment of liver affected by the bile duct injury.
The main risks of this operation are leakage from the repair site, or repeated narrowing of the duct at the area of the operation.
Common bile duct exploration
Gallstones occur in between 10 and 30% of people in the world. Usually no specific cause is found. Although gallstones usually form within the gallbladder, some stones may fall into the main bile duct, or rarely form primary within one of the bile ducts of the liver.
This may cause obstruction of the duct, resulting in jaundice or occasionally severe infection of the liver and bile duct. In most cases, these stones can be removed by using a special camera that is placed through the mouth, during a procedure called ERCP (See elsewhere on this page). Sometimes, larger stones cannot be removed endoscopically or ERCP cannot be performed for technical reasons. In such cases it may be necessary to perform an operation where the gallbladder is removed and the bile duct itself is opened for removal of the stones. Although usually this is done by key-hole surgery, it may be necessary to due do this with an open operation.
The main risks of this operation is leakage of bile from the area where the duct is cut open for removal of the stone, or rarely narrowing of the common bile duct at the site of the operation.