Pancreatitis is inflammation of the pancreas. In severe cases, the pancreas may become permanently damaged. Surgery can help slow or prevent additional damage, as well as provide pain relief.
Inflammation that develops quickly (acute pancreatitis) may resolve on its own or with a combination of rest and medication.
In some cases, acute pancreatitis can become severe, increasing your overall risk of complications. You may need surgery to confirm the diagnosis and remove the affected pancreatic tissue.
Surgery can also treat reoccurring or persistent inflammation (chronic pancreatitis).
Sometimes, you need a laparoscopy to confirm the diagnosis, as blood tests and scans can only do so much. The procedure is carried out while you’re under general anesthetic.
Your surgeon will make several small cuts in your abdominal wall and pass a camera through so that they can look directly at the organs in your abdomen or pelvis.
From there, your care team will review their findings with you and advise you on any next steps. This may involve scheduling one of the procedures listed below.
There might be small complications, such as bleeding or infection, at the operation site. More serious complications like peritonitis and requiring an emergency re-operation are rare.
If your care team identifies an obstruction in your bile ducts, they may recommend a Puestow or Frey procedure.
A Puestow procedure is also known as a lateral pancreaticojejunostomy. Your surgeon will make an incision in your abdomen to access your pancreas.
They will open the main pancreatic duct and connect it to a loop of the small intestine so the pancreas drains directly into the intestines. Poor drainage could be a sign that the procedure wasn’t effective.
As a result, the Puestow procedure can sometimes be combined with the removal of part of the head of the pancreas. This is known as the Frey procedure.
Both procedures are generally safe, with no risk added in the Frey procedure. There’s a very low mortality rate, as well as a low morbidity rate.
If your surgeon identifies pancreatic ductal stones (gallstones), they may also recommend intraoperative pancreatoscopy and electrohydraulic lithotripsy (EHL).
If your care team determines that a duct is blocked in the neck of the pancreas, they may recommend a distal pancreatectomy to remove the tail and body of the pancreas.
Distal pancreatectomy isn’t as popular as other procedures to help treat pancreatitis. However, it can be a suitable option if you have left-sided pancreatitis.
Sometimes, removal of the spleen is necessary during a distal pancreatectomy.
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There was one death during the surgery, while the death rate during the 20-year follow-up period was 10%, most often related to alcohol consumption.
Side effects might include bleeding, infection, and digestive juice leaks. More serious complications may include thrombosis, heart attack, or stroke, but these are rare.
A pancreatoduodenectomy, also known as a Whipple procedure, involves a number of separate procedures.
Your gallbladder, the head of your pancreas, part of your bile duct, and part of your small intestine will be removed, as well as a section of your stomach.
Then, your surgeon will attach your stomach to your small intestine, the tail of your pancreas to the end of your small intestine, and the remainder of your bile duct to your small intestine.
This is a complex surgery that can take a number of hours altogether. However, it’s often successful in treating chronic pancreatitis, pancreatic cancer, cancer of the small intestine, and bile duct cancer.
Being such a complex surgery, there are potential complications. These include infection, bleeding, bile or pancreatic leak, and delayed gastric emptying (gastroparesis).
You’ll likely spend the first night after surgery in intensive care, followed by a week or two in the hospital.
You won’t be able to eat for a few days to allow your digestive system to heal. You may not have a bowel movement for a few days, either.
Your healthcare team will likely encourage you to start walking the day after your surgery, gradually increasing the distance day by day. You might feel fatigued for a couple of months.
If other treatments haven’t worked, your surgeon may recommend a total pancreatectomy.
During the procedure, your surgeon will divide off and detach the end of the stomach that leads to the small intestine, where the pancreas and gallbladder both attach.
They will remove your pancreas and the adjoined section of your small intestine, as well as your bile duct, gallbladder, and often your spleen.
Your surgeon will connect your stomach and bile duct to your small intestine. After surgery, you’ll have a tube draining the abdomen, a nasal tube into the stomach, and a catheter in your bladder.
Sometimes, a total pancreatectomy can be combined with an islet cell autotransplant. This is a transplantation of your own insulin-producing cells to prevent diabetes.
If you have a total pancreatectomy without an islet cell autotransplant, you’ll need insulin for the rest of your life.
Surgery of any kind carries some degree of risk. However, the above procedures are generally safe. Your care team will work with you to determine the best surgery for your medical needs.
You may have an increased risk of developing diabetes following surgery. If part of the pancreas is removed, there’s a chance that the remaining portion may not be able to produce sufficient insulin to manage your blood sugar levels.
Your pancreas may not be able to produce the enzymes required to digest food, so you might have to take enzyme supplements moving forward.
According to a 2023 study of people who received surgery for chronic pancreatitis, just under two-thirds (63.5%) survived after ten years.
Over a quarter (26.9%) of people were still using opioids daily to manage pain, but many people have been able to live for a number of years with a good quality of life following surgery for pancreatitis.
Adam England lives in the UK, and his work has appeared in a number of national and international publications. When he’s not working, he’s probably listening to live music.