PANCREATIC SURGERY

What is Pancreatic Surgery?

The pancreas is a relatively small organ located in the middle of the abdomen behind the stomach, with its head resting on the duodenum and its tail extending to the spleen on the left, measuring 15-25 cm in length and weighing 55-70 grams. The pancreas produces two types of secretions. The enzymes it secretes are released into the duodenum via the pancreatic duct, which play a role in the digestion of food. The hormones it secretes mix directly with the blood and perform very important tasks in the body, especially sugar metabolism. If the pancreas loses function, diabetes and fatty diarrhea occur. Its location is in a very critical area. The main vessels, the aorta and vena cava, run right behind it, and the portal vein, which provides the main blood flow to the liver, passes through it. The superior mesenteric artery, which is the main artery feeding the intestines, also passes through the pancreas. In addition, the main bile duct (choledoch) enters the pancreas and opens into the duodenum. Due to its critical location and proximity to vascular structures, it is an extremely difficult organ to operate on and must be performed by experienced hands and centers.

Acute Pancreatitis

It is an inflammatory disease of the pancreas gland. It is a life-threatening event. It is usually a disease of middle-aged women/men. Although it is referred to as an inflammatory disease, bacteria later become involved. Initially, the event is the destruction of pancreatic tissues by pancreatic enzymes.

Gallbladder and bile duct stone disease, alcoholism, excessive food consumption (uncontrolled excessive eating and drinking at once), hypertriglyceridemia (high blood fat), some endoscopic procedures (ERCP) performed on the bile ducts, some medications and some infectious diseases can cause acute pancreatitis.

It can cause symptoms such as a belt-like pain in the middle of the abdomen around the belly button spreading to the back, loss of appetite, nausea and vomiting, fever, jaundice if there is a problem with bile flow and in severe cases, water accumulation in the abdomen.

Acute pancreatitis can be easily diagnosed with examination, laboratory and radiological examinations. Oral feeding of the patients is stopped. Although not absolutely necessary, antibiotics may be required in some cases. Drugs that reduce stomach acid secretion are given. Surgery is only performed in patients who develop abscess and necrosis (gangrene) in the pancreas region. If the cause is stones in the gallbladder and its ducts, surgery should be performed on the gallbladder and its ducts as soon as possible after treatment.

Chronic Pancreatitis

Chronic (chronic) pancreatitis is an inflammation of the pancreas that either begins as a result of a sudden attack of pancreatitis or insidiously and progresses in a chronic manner. Once chronic pancreatitis begins, it progresses gradually. Sometimes, sudden attacks of exacerbation are seen. In approximately half of chronic pancreatitis cases, calcification foci are encountered in the pancreas. The inflammatory process causes the pancreatic tissue to be replaced by a gradually increasing scar tissue, eventually resulting in inadequate pancreatic function. Chronic pancreatitis is closely related to alcoholism.

As a result of impaired pancreatic function, fat and protein absorption in the digestive tract is impaired and weight loss occurs. Since the absorption of fat-soluble vitamins K, E, A, and D is also impaired along with fat absorption, cramp-like contractions, bleeding in the skin, bruising, and some disorders in clotting are observed accordingly. Diabetes can also develop in some patients with chronic pancreatitis. Chronic pancreatitis patients have a 4% risk of developing pancreatic cancer.

Patients have recurrent abdominal pain. The presence of abdominal pain in patients who consume excessive amounts of alcohol is very significant in terms of chronic pancreatitis. There is no definitive treatment for the disease. Eliminating alcohol use is a very effective first step in treatment. Oral administration of enzymes that the pancreas cannot secrete also plays an important role in treatment. Various surgical interventions can be performed on patients whose pain cannot be controlled and who are suspected of having cancer.

Pancreatic Cancer

It is a type of cancer that is usually diagnosed in advanced stages and often cannot be curatively operated on. 90% of cancers are located in the head of the pancreas. Cancers located in this region can cause jaundice and be diagnosed earlier because they block the main bile duct. Trunk tumors are diagnosed later because they cause complaints very late. If there is weight loss and jaundice in older people, pancreatic cancer should definitely be considered and examinations should be done accordingly. Weight loss is largely the first finding (79%). In addition, pain (56% spreads to the back in a belt manner), loss of appetite (28%) and jaundice (25%) can be seen.

The deep location of the organ in the abdomen causes complaints to occur late in patients and the diagnosis is delayed. It is a tumor with a high growth rate and can reach large diameters in a short time. Tumor cells can spread to other organs and lymph nodes, especially the liver, by mixing with the bloodstream in the early stage.

Diagnosis is made with clinical, laboratory and radiological examinations.

In the treatment, different surgical methods, chemotherapy, local ablative treatments and radiotherapy are used according to the location and stage of the disease.

In the Whipple operation (Radical pancreaticoduodenectomy) performed in cancers located in the head of the pancreas; the head and neck of the pancreas, the lower-middle part of the main bile duct, the gallbladder, the duodenum, the lower 1/3 of the stomach, the uppermost 15-20 centimeters of the small intestine are removed together with the surrounding lymphatic tissues. Then, connections are made in anatomical order and the patient's normal post-operative eating and digestive functions are tried to be continued. It is one of the largest operations in General Surgery and is a surgery that carries a mortality risk of around 1-3% even when performed by experienced surgeons. It must be performed by people and centers specialized in this field.

The portal vein is a vein that passes just behind the pancreas and carries 75% of the blood going to the liver. Even in cases where the cancer has spread to this area, Whipple surgery can be performed today by removing the portal vein and placing a synthetic vein in between.

The information contained within the site is for support purposes only. It does not replace a physician's examination, diagnosis, and prognosis of a patient for medical purposes.

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