Pancreatectomy, total
CPT4 code
Name of the Procedure:
Pancreatectomy, Total
- Common Name: Total Pancreatectomy
- Medical Term: Pancreatectomy
Summary
A total pancreatectomy is a surgical procedure where the entire pancreas is removed. This is often performed to treat certain serious conditions of the pancreas, such as cancer, chronic pancreatitis, or severe trauma.
Purpose
The procedure aims to remove the diseased or damaged pancreas to alleviate symptoms, treat pancreatic cancer, or manage chronic pancreatitis. It may also be necessary in cases of severe trauma to the pancreas.
Indications
- Pancreatic cancer
- Chronic pancreatitis unresponsive to other treatments
- Severe pancreatic trauma
- Non-cancerous pancreatic tumors
- Cystic fibrosis, in some cases
Preparation
- Fasting for at least 8 hours prior to surgery
- Adjusting or discontinuing certain medications as advised by the doctor
- Undergoing preoperative tests, such as blood tests, imaging studies (CT or MRI scans), and possibly an endoscopic examination
Procedure Description
- The patient is placed under general anesthesia.
- An incision is made in the abdomen to access the pancreas.
- The entire pancreas along with parts of other organs (such as the duodenum, gallbladder, and sometimes a portion of the stomach or small intestine) are carefully removed.
- Reconstruction is performed to ensure normal gastrointestinal and bile flow.
- Surgical drains may be placed to remove any excess fluid from the surgical area.
- The incision is closed with sutures or staples.
Duration
The procedure typically takes between 5 to 7 hours.
Setting
Total pancreatectomy is performed in a hospital operating room.
Personnel
- Lead Surgeon (usually a specialized pancreatic or gastrointestinal surgeon)
- Anesthesiologist
- Surgical nurses
- Surgical assistants
- Possibly other specialists (e.g., a vascular surgeon if major blood vessels are involved)
Risks and Complications
- Common risks: Infection, bleeding, delayed gastric emptying, and digestive issues
- Rare risks: Blood clots, damage to nearby organs, diabetes as a result of removing insulin-producing cells, and nutritional deficiencies
Benefits
- Effective removal of cancer or diseased tissue
- Relief from chronic pain and symptoms of pancreatitis
- Potential cure for certain tumors
- Improved quality of life
Recovery
- Initial hospital stay of 7-14 days, depending on individual circumstances
- Initial post-operative care includes pain management, IV fluids, and nutritional support
- Long-term care involves learning to manage diabetes (since the pancreas is removed), enzyme replacement therapy, and possible dietary modifications
- Full recovery may take several months, with follow-up appointments to monitor progress and manage any post-surgical issues
Alternatives
- Partial pancreatectomy (removal of a portion of the pancreas)
- Distal pancreatectomy (removal of the body and tail of the pancreas)
- Non-surgical options such as medication, radiation, or chemotherapy, depending on the underlying condition
- Pros and cons: Less extensive surgeries or non-surgical treatments may have fewer immediate risks but might not be as effective for certain conditions
Patient Experience
- Pre-procedure: Anxiety and discomfort due to fasting and preoperative preparations
- During procedure: The patient will be under general anesthesia and not conscious
- Post-procedure: Expect to feel groggy and experience some pain initially managed with medication. Gradual increase in activity level as recovery progresses, with attention to diet and blood sugar management due to the loss of pancreatic function. Pain relief will be provided, and support from healthcare professionals will aid in managing any post-operative discomfort.