Removing the body and tail of the pancreas: What you need to know

Among the operations of the digestive system, resection of the body and tail of the pancreas is a difficult and complicated operation because it involves many large blood vessels. When cutting, if the suture is not good, there is a risk of pancreatic leakage, the enzymes are out of control leading to the decomposition of nearby tissues.

1. Pancreatic body and tail resection is indicated and contraindicated in which case?

After monitoring the test results, the doctor will perform a pancreatectomy for the following patients:
Cancer of the body or tail of the pancreas. Benign tumors of the body or tail of the pancreas are at risk of malignancy. True cyst in the body or tail of the pancreas. Rupture of the body or tail of the pancreas due to trauma. If the patient has one of the following cases, then surgery to remove the body and tail of the pancreas will not be performed:
T4 stage cancer invades important vascular structures such as the superior mesenteric vascular bundle or hepatic artery, splenic bundle, or peritoneal metastases. The patient had peritonitis due to late rupture of the body or tail of the pancreas. Progressive acute pancreatitis. The patient is on a treatment regimen with contraindications to anesthesia or has cardiovascular and respiratory disease with contraindications to intra-abdominal inflating.
Viêm tụy cấp diễn biến nhanh, nguy cơ tử vong cao
Bệnh nhân bị viêm tụy cấp sẽ không được phẫu thuật cắt thân và đuôi tụy

2. What preparation is required for surgery to remove the body and tail of the pancreas?

Because it is one of the difficult surgeries, the person performing must be a hepatobiliary surgeon with experience in laparoscopic surgery, an experienced anesthesiologist and anesthesiologist.

2.1 Instruments used during surgery

System of machines and specialized laparoscopic surgical instruments for the abdominal region. Instruments to control hemostasis include: Ultrasonic cutter or ligasure, bipolar hemostatic burner, hemolock. Use a straight or angled (Flex) splicing cutter using a 60mm white vascular cartridge.

2.2 For sick people

Preoperative clinical examination. Routine preoperative testing. Assess surgical risk when necessary. CT Scan of the abdomen with injection or MRI of the abdomen with magnetic contrast. In some cases, to assess the stage of cancer, patients are indicated to perform ultrasound through gastroscopy. In some cases, patients are assigned to biopsy the tumor under the guidance of ultrasound or CT Scan to confirm the preoperative diagnosis. Prepare the oral colon in case of need.

2.3 Medical records

Administrative procedures need to be completed according to regulations: Detailed medical records, minutes of consultation, minutes of examination before anesthesia, written commitment to consent to surgery.
Phẫu thuật về trong ngày
Bệnh nhân cần hoàn thành thủ tục hành chính trước khi phẫu thuật

3. What doctors and patients need to pay attention to during and after surgery

During surgery to remove the body and tail of the pancreas, if:
The tumor is large and unable to be operated on laparoscopically, switch to open surgery. Patients with uncontrolled bleeding through laparoscopic surgery: switch to open surgery. The transverse colon is injured when cutting the gastrocolic fascia: depending on the extent of the damage and the condition of the colon, the perforation can be sutured or the colon opened to the skin. In case of ischemia of a segment of the transverse colon due to damage to the limbal vascular bundle of the colon: monitor the patient's condition to perform a resection of the ischemic colon to reconnect or bring the two ends to the skin. After the doctor performs the surgery to remove the body and tail of the pancreas according to medical procedures, the patient needs to be rehydrated with enough water-electrolytes, daily energy, enough protein, albumin and blood.
Besides, it can be prescribed to use pain relievers or prophylactic antibiotics. Depending on the severity of the infection, the duration of combination antibiotics should be longer. Patients drink sugar water, milk on the first day after surgery, eat soon after having a bowel movement.
The doctor needs to monitor and handle the following cases:
Bleeding: Intra-abdominal bleeding (monitoring through drainage, vital signs and blood count tests): Close monitoring is required depending on the extent that is needed. necessitating immediate re-surgery through laparoscopic or open surgery. Occurrence of pancreatic fistula: Monitor through drainage (color, volume, amylase test/drainage), in most cases, conservative treatment is indicated, re-operation is indicated if the fistula state after surgical removal of the trunk. and tail of the pancreas create an intra-abdominal abscess or peritonitis. Intestinal obstruction due to adhesions after surgery: Rarely, monitor and manage as mechanical intestinal obstruction. Any questions that need to be answered by a specialist doctor as well as if you have a need for medical examination and treatment at Vinmec International General Hospital, you can contact Vinmec Health System nationwide or register online HERE.
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