Distal Pancreatectomy: Indications, Procedure, and Risks

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What is this Procedure?

Distal pancreatectomy is a surgical procedure that removes the end part of the pancreas and leaves the top half of it intact and attached. This surgery is commonly performed to remove a tumor or small cancer located at the middle or tail part of the pancreas. It may also be carried out to treat some cases of pancreatic pseudocysts, chronic pancreatitis and traumatic injuries to the pancreas. Once the tail part of the pancreas is removed, the portion where the incision was made is stitched up to stop the seepage of pancreatic enzymes and digestive juices. Sometimes the adjacent spleen is excised as well when the artery or vein of the spleen is affected by the disease.

What are the Preparations Involved Prior to Surgery?

Prior to the surgery, each individual must first go through a comprehensive diagnostic work-up to ensure accurate diagnosis of the disease**.** Examples of these tests are CT scan, x-ray, ultrasound, and various visual imaging techniques. Some patients with cancer in the pancreas are given chemotherapy treatment to shrink the tumor before going to surgery.

The night before the surgery, the patient is placed on a twelve hour fasting period. On the day of the surgery, pre-operation medicine is given to prevent infection which can occur after the operation.

What are the Risks?

This procedure has general risks similar to any other surgical procedure such as allergic reaction to the anesthesia, pain, bleeding and infection. This particular surgery may also bring about the possibility of the pancreas not being able to produce and release enough amounts of juices and hormones, thus, resulting in delayed gastric emptying. Another common possible complication is pancreatic anastomotic leak, which is seepage in the connection made between the remainder of the pancreas and the other organs in the abdomen.

How is the Procedure Performed?

The patient is usually placed under general anesthesia. Distal pancreatectomy can be performed either through an open technique or through laparoscopy. In the open technique, the surgeon makes one big incision in the abdomen to locate the pancreas and do the surgery. In the laparoscopic procedure, four small incisions are made in the abdomen and thin tubes with a camera and surgical instruments are inserted to perform the procedure. In removing the tail of the pancreas, blood vessels are fastened together while the pancreas are stapled and divided for excision. If the splenic artery or vein is distressed by the illness, the spleen is also removed.

What Happens During the Recovery Period?

This procedure is considered majory surgery, and the patient may stay in the hospital for about two to three weeks. He is regularly monitored for any signs of infection after the surgery. Some individuals may have chemotherapy or radiation after the surgery.

After discharge from the hospital, the patient can resume his normal daily activities in about a month. He is however, advised not to do intense lifting, straining and exertions for at least six weeks to eight weeks after the surgery.


Encyclopedia of Surgery: Pancreatectomy

Center for Pancreatic and Biliary Disease: Distal Pancreatectomy