Pancreatectomy (removal of portion of pancreas)

The Condition

Panceatectomy is performed for benign and malignant tumors / diseases of the pancreas.

Symptoms

• Nausea, vomiting
• Jaundice
• Abdominal pain
• Weight loss, weakness

The procedure

The operation can be performed open or laparoscopically.  The open approach is done with a large incision which can be in the midline or below the chest.  The laparoscopic approach requires about 5-6 small incisions in the abdomen. A port (nozzle) is inserted into one of the slits, and carbon dioxide gas inflates the abdomen. This process allows the surgeon to see inside of the abdomen more easily. A laparoscope is inserted through another port. The laparoscope looks like a telescope with a light and camera on the end so the surgeon can see inside the abdomen. Surgical instruments are placed in the other small openings and used to remove the portion of the pancreas which contains the tumor. The pancreas is closely positioned to many other organs, such as the duodenum, stomach, colon, spleen, and major blood vessels. This operation can require many hours to complete because of its complexity. The pancreas is cut out with surgical staplers. The pancreas specimen then is removed from the abdomen by enlarging one of the small incisions for the laparoscopic surgery, and for the open surgery through the already existing incision.  Reconnections of the gastrointestinal tract may be required and can be done either hand sewn or by staplers. Sometimes a small rubber drain is placed at the surgery site inside the abdomen, and this exits through the skin. After all this has been accomplished, the carbon dioxide is released out of the abdomen through the slits, and then these sites are closed with sutures or staples, or covered with glue-like bandage and steri-strips.

Nonsurgical Treatment

Sometimes the malignancy may be treated with chemotherapy and non-malignant diseases can be treated medically or expectantly.  The doctor should discuss with the patient all possible options.

Risks

• Infection of the skin at the incision
• Postoperative ileus (the intestines slow down/stop working for several days)
• Small bowel obstruction (kinking of the small bowel, causing blockage)
• Leakage of pancreatic juice at the surgical site
• Disruption of intestinal connection leak
• Bleeding
• Collection of pus inside the abdomen (intraabdominal abscess)
• Death
• Pancreatic fistula

Medical Negligence

The above mentioned risks and complications are known to happen with pancrearectomy  (removal of a portion of the pancreas) and such complications do not necessarily constitute deviation from the medical standard of care.  The following examples however may be considered as medical negligence.

• Leakage of pancreatic juice is recognized to happen in 13% of distal pancreatectomies.  Failure however to diagnose and treat this complication can lead to major morbidity.
• Disruption of intestinal connection can lead to major complications including sepsis and death if not diagnosed and treated early.