Name of the Procedure:

Distal Subtotal Pancreatectomy, with or without Splenectomy; without Pancreaticojejunostomy

Summary

A distal subtotal pancreatectomy is a surgical procedure in which the tail and part of the body of the pancreas are removed. Depending on the situation, the spleen may also be removed, but no connection (anastomosis) between the pancreas and the intestines is created.

Purpose

This procedure is performed to treat or manage pancreatic tumors, chronic pancreatitis, or other pancreatic diseases that affect the tail and body of the pancreas. It aims to remove diseased tissue to alleviate symptoms or prevent the spread of cancer.

Indications

• Pancreatic cancer located in the tail or body of the pancreas.
• Chronic pancreatitis that is unresponsive to other treatments.
• Benign pancreatic tumors or cysts.
• Traumatic injury to the pancreas.
• Certain cases of pancreatic abscess.

Preparation

• Patients are usually required to fast for at least 8 hours before surgery.
• Blood tests, imaging studies (like CT or MRI scans), and other diagnostic tests may be performed.
• Medication adjustments may be necessary, particularly for blood thinners.

Procedure Description

1. The patient is administered general anesthesia to ensure they are asleep and pain-free.
2. An incision is made in the abdomen to access the pancreas.
3. The surgeon identifies and isolates blood vessels supplying the tail and body of the pancreas.
4. The tail and part of the body of the pancreas are carefully removed.
5. If necessary, the spleen is also removed.
6. The remaining pancreas is left without creating a new connection to the intestine (no pancreaticojejunostomy).
7. The incision is closed with sutures or staples.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity and whether the spleen is also removed.

Setting

This surgery is performed in a hospital operating room.

Personnel

• General or specialized pancreatic surgeon
• Surgical nurses
• Anesthesiologist
• Surgical assistants

Risks and Complications

• Infection
• Bleeding
• Pancreatic fistula (leakage of pancreatic fluids)
• Postoperative diabetes
• Injury to surrounding organs
• Splenic vein thrombosis (if spleen is removed)

Benefits

• Relief from symptoms caused by pancreatic disease.
• Removal of cancerous or pre-cancerous tissues, potentially improving survival rates.
• Improved quality of life if symptoms of chronic pancreatitis are alleviated.

Recovery

• Hospital stay of about 5 to 10 days post-surgery.
• Pain management with medications.
• Gradual reintroduction of food and drink.
• Instructions on caring for the surgical wound and activity restrictions.
• Follow-up appointments to monitor recovery and manage any complications.
• Depending on the condition treated, lifestyle adjustments and further treatments may be necessary.

Alternatives

• Observation and symptomatic treatment for less severe conditions.
• Medication management for chronic pancreatitis.
• Endoscopic procedures for cyst drainage or to remove small tumors.
• Total pancreatectomy for more extensive disease.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Post-procedure, patients can expect some pain and discomfort, which will be managed with medications. There will be a recuperation period where strength and normal function gradually return. Some lifestyle changes might be necessary, especially in dietary habits and monitoring of blood sugar levels if significant portions of the pancreas are removed.