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Pancreatic Surgery

PD exposure of pancreatic neck
PD - portal vein resection
PD completed pancreaticojejunosomy and hepaticojejunostomy

There are 2 procedures most commonly performed for pancreatic diseases, particularly tumours, and these are pancreaticoduodenectomy and distal pancreatectomy.

Pancreatic surgery for cancers are extensive procedures, usually performed by open surgery through a large incision in the upper abdomen. The pancreas is an organ in a pretty complicated location at the back of the upper abdomen – it is close to major blood vessels (veins and arteries) that take blood to and drain blood from the liver, stomach, spleen, the small intestine and half of the large intestine. The head of the pancreas sits in the curve of the duodenum, which is the first part of the small intestine just beyond the stomach.

The rationale for the types of surgery for pancreatic cancers is to try and remove the tumour in its entirety, as well as the draining lymph nodes as well as certain anatomic areas that are commonly involved by tumour spread.

A pancreaticoduodenectomy (often called a Whipple’s procedure or a Kausch-Whipple procedure) is performed for tumours of the head of the pancreas, end of the bile duct, the ampulla, or certain parts of the duodenum. This involves removal of the head of pancreas, duodenum, a small portion of the end of the stomach, gallbladder and bile duct. Sometimes portions of certain veins (usually the portal or superior mesenteric veins) are involved or suspected to be involved by the tumour, and if feasible may also be removed and either repaired or reconstructed. The operation takes 4-6 hours, and the average post-operative stay in hospital is 7-10 days.

A distal pancreatectomy is performed for tumours of the body and tail of the pancreas. Depending on the type of tumour and its location, it may be performed either with open surgery or laparoscopic (keyhole) surgery. The blood supply to and from the spleen runs along the back of the body and tail of the pancreas, and depending on the tumour type and location, it may be necessary to remove the spleen as well. The operation usually takes 3-4 hours, and the average stay in hospital is 5-7 days, some of which depends on whether the operation is completed with laparoscopic or open surgery.

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