Adam Bartlett
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Adam Bartlett FRACS PhD - HPB, Laparoscopic and General Surgeon

Pancreatic Surgery

Pancreas is a vital gland, located behind the stomach just below the liver. It produces several digestive enzymes and also plays a vital role in maintaining the blood glucose levels. Any disease or injury to the pancreas may cause several problems. Pancreatic surgery comprises a wide range of surgical procedures performed on the pancreas. Most surgeries involve a resection or removal of the diseased portion of the pancreas.

Pancreas is both an exocrine and an endocrine gland. The exocrine part produces enzymes that help in digestion and absorption of nutrients from food. The endocrine part of the pancreas secretes hormones involved in the metabolism of sugar and maintenance of blood sugar levels.

Causes of pancreatic disorder

A pancreatic disorder can be caused by either an acute or chronic pathology. Any inflammation of the pancreas may temporarily block the bile and the pancreatic duct leading to reflux of the bile into the pancreatic duct. Some of the causes of acute injury to the pancreas include excessive consumption of alcohol, certain medications, viral infections such as mumps, also hypothermia and scorpion sting. Alcohol consumption is one of the most common causes of chronic pancreatitis; the other causes of chronic pancreatitis include exposure to industrial toxins, congenital variation in pancreatic duct system and genetic factors.

Pancreatic cancer is one of the most common indications of pancreatic surgery.

Symptoms

The characteristic symptoms of pancreatic disorders include sharp, aching or burning pain over the upper and central portion of the abdomen associated with back pain (acute pancreatitis). Any enlargement or abnormality of the head of the pancreas may block the bile duct and lead to jaundice associated with dark urine, pale stools and itchy skin. Streatorrhoea is a condition characterized by loose, pale, fatty, floating, offensive bowel motions due to lack of secretion of the digestive juice from the pancreas that hampers the absorption of fats from the intestines. Pancreatic disorders interfere with digestion and sugar metabolism and the patient experiences weight loss and loss of appetite.

Surgeries

Some of the commonly performed pancreatic surgeries include Whipple's pancreatico-dudenectomy, distal pancreatectomy, pancreatic bypass, Berger's resection, pancreatic necrosectomy, drainage of pseudocysts, and thoracoscopic splanchnicectomy.

Whipple's pancreatico-dudenectomy is the most common pancreatic surgery indicated for the removal of tumors from the head of the pancreas. Distal pancreatectomy is another surgical procedure used for the removal of diseased areas from the tail and body of the pancreas. Pancreatic bypass procedure is indicated in seriously ill patients when the bile duct and duodenum is blocked by a pancreatic tumor that cannot be removed. Berger's resection is performed in patients with chronic pancreatitis for the removal of the head of pancreas. In this procedure the duodenum is left intact that helps to maintain the normal digestive functions. Pancreatic necrosectomy is usually performed in terminally ill patients with severe acute pancreatitis and in patients with dead or infected pancreas. Drainage of pseudocysts is a surgical procedure performed in patients with a collection of inflammatory fluid around the pancreas. Thoracoscopic splanchnicectomy is a keyhole procedure for the management of pain from chronic pancreatitis or untreatable tumors.

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