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Pancreatic resection refers to radical treatment methods, which means that it should be used only in exceptional cases. In practice, this implies that resection is a last resort in situations where it is not possible to cure the victim with the involvement of alternative medicine.
The pancreas, also shortened to the abbreviation PJZH or the medical term pancreas, is a tubular-alveolar unpaired organ. This adds to the problems, since it will not be possible to shift part of the duties of the operated gland to its second pair, as happens with the kidneys.
The organ is located under the gastric region in the retroperitoneal zone, which is why it is quite difficult to get there even for experienced gastroenterologist surgeons with experience. The shape of the pancreas resembles a tube, which is responsible for the generation of valuable pancreatic juice. It spreads through channels into the intestines.
Additionally, the pancreas is responsible for the production of insulin, which is a hormone necessary for the normal functioning of the whole organism. As soon as the gland ceases to perform its tasks stably due to various specialized diseases, the whole body begins to suffer. To facilitate well-being and improve the quality of life, the patient may be prescribed mandatory surgical intervention.
Medical indications
Many victims of destabilized pancreas until the last do not agree to do a partial excision – resection, believing that the disability thus obtained will ruin their lives. Doctors insist that modern pharmacology, coupled with a competent approach for the recovery period, works almost miracles. If the victim adheres to a certain set of rules of behavior and nutrition, then after the operation he will come to his senses quickly and will be able to work again, do what he loves.
Many are frightened by the fact that diabetes is among the possible side effects of surgery. But, according to statistics, this variant of the complication occurs only in 50% of clinical cases.
Before referring a person to a resection, the doctor will definitely do everything to avoid drastic measures. This applies even to situations if a neoplasm is found in a patient. First, the treating specialist must make sure whether it is benign or malignant. For this, auxiliary diagnostic formats are involved, such as computed tomography with contrast or biopsy. The latter allows you to determine the exact type of tumor found. Helps to determine the type of treatment and pancreatectomy.
If the treatment program with standard medicines did not give the expected results, or was rejected from the very beginning due to insufficient productivity, then a resection is prescribed. Before her, the victim is sent to pass a series of tests:
- electrocardiogram;
- X-ray;
- coagulogram;
- blood tests, including biochemical;
- ultrasound examination of the abdominal cavity;
- endoscopy.
Having received the results of all the listed examinations, the expert takes note of the current complaints of the applicant, his medical history and other data from the medical record, up to hereditary disposition. Based on the information collected, a person may be assigned a partial resection, which is a mandatory measure for:
- exacerbation of the chronic course of pancreatitis;
- mechanical injury;
- destruction of the integrity of the organ, which is associated with rupture and crushing;
- neoplasms of a malignant nature like carcinoma;
- cyst formation;
- the presence of a fistula;
- necrotic tissue pathologies.
Sometimes the reason for transfer to the inpatient department of gastroenterology for surgery is some rare acquired or congenital disease, which is more related to atypical manifestations.
Classification of resections
There are several varieties of this format of surgical intervention, which differ in the scheme of conduct, the amount of excised material, as well as the features of localization of the lesion.
The modern classification implies the following divisions:
- distal;
- corporocaudal;
- head and tail removal.
The distal variation involves partial removal of the tail and part of the body of the gland on the left side. The corporocaudal version is aimed at freeing the patient from a cancerous tumor. It is usually localized both within the pancreas itself and in its caudal compartment. Due to the anatomical features, surgeons remove the spleen along with the pancreas. Such a complex intervention takes place under the term splenectomy.
Separately, situations are considered when the detected neoplasm turned out to be inoperable. Then you have to use palliative care. This means that the technique is not characterized by the complete removal of the problem area by radical measures.
Regardless of which course of the operation was chosen, it should only be carried out by a qualified specialist together with a professional medical team. It is especially difficult if the victim is scheduled for Frey’s operation, or a combined resection of the stomach, which implies many hours of work to save a person.
Each doctor tries to preserve healthy pancreatic tissues as much as possible so that they continue to fulfill their direct duties. But sometimes it is quite difficult because of the need to adhere to the rules of lymph node dissection. We are talking about the associated removal of fiber along with the vascular network, lymph nodes located near the problem area.
No less difficult in practice are laparotomy or total resection, which involves the excision of the entire organ, often along with neighboring ones. Usually, part of the stomach, as well as the spleen and duodenum, fall under the scalpel.
head resection
In medical practice, head resection is one of the most popular options for intervention on the pancreas. This is explained by the fact that for some reason tumors or cysts are most often localized there.
To increase the chances of a successful early recovery, the course of the surgical procedure is divided into several stages:
- removal of the affected area;
- excision of affected adjacent areas from adjacent internal organs;
- restoration of the integrity of working channels;
- reconstruction of the alimentary canal;
- return of gallbladder function.
To get to the gland far hidden in the abdominal cavity, doctors use general anesthesia. But here you should carefully consider those people who have not previously experienced anesthesia on themselves. They should first conduct an allergic test to avoid the risks of anaphylactic shock.
In order to free up a viewing angle for himself, the expert uses special equipment – a laparoscope, and the operation itself receives a laparoscopic postscript.
With the help of a high-precision device, it will be possible to study the condition of the organs, as well as inspect the intended area for the operation. At its very beginning, the specialist is obliged to block the vessels that feed the pancreas. Then the main phase is performed, and everything ends with the reconstruction of the digestive system.
For this, it is necessary to articulate the pancreas with the intestines and stomach, for which anastomoses are involved. This means that some organs will be connected to each other so that they “learn” to do the work for those that had to be removed.
When should the tail be removed?
To increase the chances of a successful outcome, tail resection is almost always accompanied by removal of the spleen. To reduce the load on the body, you first need to tie up a whole group of vessels. Only after that, a pulp is applied to the tail element and the affected section of the pancreas is crossed.
According to the protocol, the next phase is the application of a special surgical thread called a ligature. It is applied on the formed stump – the place where the tail is cut. At the same time, it is necessary to control the prevention of heavy bleeding, which is done by tying the vessels.
After partial pancreatotomy, the possible negative consequences practically disappear. This means that the risks of subsequent development of diabetes tend to zero. The final point includes drainage with closure of the abdominal cavity.
Relevance of pancreas body resection
Removal of the body of the gland is sometimes a forced measure, which should not be resisted in order to maintain a general normal state of health. Unlike the tail and head parts, the body is cut along the line of the lower edge. This means that the back side of the peritoneum is taken as the starting point.
This is followed by a bypass from the bottom of the pancreas to gently free it from the overgrown fiber. Only after that you can proceed to the study of blood vessels and the spleen. As soon as the pulp is applied, it is allowed to cross the corresponding section of the organ.
To protect the mesenteric vessels, the surgeon will definitely use the Kocher probe. And if there was heavy bleeding in the process, then it is intercepted with the help of the so-called mosquitoes, and then completely bandaged.
The distal part is mandatory for resection, after which the doctor cuts a flap from the omentum to cover the proximal segment with it. This means that the cut out soft fabric should cover the piece located closer to the center. It turns out a subtotal operation, when only the problematic part is excised.
For the success of transverse resection, a purse-string suture is used, which perfectly covers even an extensive wound surface.
Postoperative recovery
Doctors insist that rehabilitation after resection is as important as the operation itself. This is explained by the fact that after surgery, the patient often fixes poor absorption of substances coming from food. Because of this, the body faces an acute deficiency of digestive enzymes.
To neutralize discomfort in the peritoneum on a regular basis, you will have to use enzyme-containing preparations, which are prescribed by the attending physician strictly individually. He will tell you the mode of their reception, a specific dosage. When resection of a large part of the pancreas, insulin is additionally prescribed according to the circumstances.
In the first days after the operation, a person is generally obliged to adhere to the basics of therapeutic starvation, as well as follow the doctor’s instructions. If the patient has become a victim of pancreatic necrosis of the pancreas, then he will have to appear more often for examination by a gastroenterologist after discharge. Such categoricalness is explained by the increased risks of possible complications.
Life after the removal of this organ does not end, you just need to adhere to the right diet. Nutrition should exclude provocative foods, including potatoes, as well as confectionery and other sweets, coffee, fried foods, whole milk.
The traditional protein diet provides for a complete rejection of problematic fatty foods and spicy, smoked foods. All of them put too much stress on the weakened digestive system. Pickles are banned. And everything else becomes available again.
The main thing is to eat small meals throughout the day and drink at least one and a half liters of water in order to maintain the water balance at the proper level. Quitting bad habits also improves health.