Pancreatectomy, distal, near-total with preservation of duodenum (Child-type procedure)
CPT4 code
Name of the Procedure:
Pancreatectomy, Distal, Near-Total with Preservation of Duodenum (Child-type Procedure)
Summary
In a pancreatectomy, distal, near-total with preservation of the duodenum (Child-type procedure), surgeons remove a significant portion of the pancreas, leaving behind the duodenum (the first part of the small intestine). This surgery often aims to treat various pancreatic disorders while attempting to maintain some pancreatic function and normal digestion.
Purpose
The primary goal of the procedure is to address conditions affecting the pancreas, such as tumors, chronic pancreatitis, or trauma, while preserving the duodenum to aid in digestion. This surgery aims to relieve symptoms, remove diseased tissue, and maintain as much normal pancreatic function as possible.
Indications
- Pancreatic tumors (benign or malignant)
- Chronic pancreatectomy
- Pancreatic cysts or pseudocysts
- Significant trauma to the pancreas
- Certain cases of insulinoma or other endocrine pancreatic tumors
Preparation
- Fasting for at least 8 hours before surgery
- Adjusting or stopping certain medications as directed by the healthcare provider
- Preoperative imaging tests such as CT scans or MRI
- Blood tests and a thorough medical evaluation
Procedure Description
- The patient is placed under general anesthesia.
- A surgical incision is made in the abdomen.
- The surgeon carefully identifies and isolates the pancreas.
- The distal portion of the pancreas is dissected and removed while ensuring the duodenum remains intact.
- Protective measures are taken to preserve major blood vessels and other surrounding organs.
- Drains may be placed to help prevent fluid accumulation.
- The incision is closed using sutures or staples, and a sterile dressing is applied.
Tools and equipment may include scalpels, retractors, surgical scissors, and electrosurgical units. The procedure requires meticulous surgical techniques to minimize complications.
Duration
The procedure typically takes 3 to 5 hours, depending on the complexity and the individual patient's condition.
Setting
The surgery is performed in a hospital setting, most often in a specialized surgical suite.
Personnel
- Primary surgeon (typically a surgical oncologist or gastrointestinal surgeon)
- Surgical assistants
- Scrub nurse and circulating nurse
- Anesthesiologist
- Operating room technicians
Risks and Complications
- Bleeding
- Infection
- Pancreatic fistula (leakage of pancreatic fluid)
- Delayed gastric emptying
- Diabetes (due to reduced pancreatic function)
- Nutritional deficiencies
Benefits
- Removal of diseased or problematic portions of the pancreas
- Preservation of the duodenum and some pancreatic function
- Relief from symptoms like pain or obstruction
- Potential to stabilize or cure pancreatic cancer
Recovery
- Hospital stay of 5 to 10 days post-surgery
- Pain management with medications
- Gradual reintroduction to eating with a focus on a balanced diet
- Restrictions on heavy lifting and strenuous activities for several weeks
- Follow-up appointments for monitoring recovery and managing any complications
Alternatives
- Whipple procedure (pancreaticoduodenectomy)
- Total pancreatectomy
- Conservative management with medication and lifestyle changes
- Non-surgical treatments like chemotherapy or radiation in the case of cancer
Each alternative has its own set of risks and benefits, depending on the specific condition treated.
Patient Experience
Patients may experience abdominal pain, fatigue, and discomfort post-surgery. Pain will be managed with medication. Recovery involves a gradual return to normal activities, dietary adjustments, and regular follow-up care. Patients should report any unusual symptoms or complications to their healthcare provider promptly.