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Information you need to understand your disease and the tests you may need.
What is Whipple's Pancreaticoduodenectomy
The Whipple procedure involves removal of the "head" (wide part) of the pancreas next to the first part of the small intestine (duodenum). It also involves removal of the duodenum, a portion of the common bile duct, gallbladder, and sometimes part of the stomach. Afterward, surgeons reconnect the remaining intestine, bile duct, and pancreas.
Why is it done?
A Whipple procedure may be a treatment option for people whose pancreas, duodenum or bile duct is affected by cancer or other disorder.
Whipple procedure might be recommended to treat:
- Pancreatic cancer
- Pancreatic cysts
- Pancreatic tumors
- Pancreatitis
- Ampullary cancer
- Bile duct cancer
- Neuroendocrine tumors
- Small bowel cancer
- Trauma to the pancreas or small intestine
- Other tumors or disorders involving the pancreas, duodenum or bile ducts
The goal of doing a Whipple procedure for cancer is to remove the tumor and prevent it from growing and spreading to other organs.
What are the risks associated with it
It carries risks of open surgery - both during and after surgery. These may include:
- Bleeding at the surgical areas
- Infection of the incision area or inside your abdomen
- Delayed emptying of the stomach, which may make it difficult to eat or to keep food down temporarily
- Leakage from the pancreas or bile duct connection
- Diabetes, temporary or permanent
How it is it done
A Whipple procedure may be done in various ways:
- Open surgery. During an open procedure, your surgeon makes an incision in your abdomen in order to access your pancreas. This is the most common approach and the most studied.
- Laparoscopic surgery. During laparoscopic surgery, the surgeon makes several smaller incisions in your abdomen and inserts special instruments, including a camera that transmits video to a monitor in the operating room. The surgeon watches the monitor to guide the surgical tools in performing the Whipple procedure. Laparoscopic surgery is a type of minimally invasive surgery.
- Robotic surgery. Robotic surgery is a type of minimally invasive surgery in which the surgical tools are attached to a mechanical device (robot). The surgeon sits at a console nearby and uses hand controls to direct the robot. A surgical robot can use tools in tight spaces and around corners, where human hands may be too large to be effective.
What to expect from procedure
After your Whipple procedure, you can expect to:
Most people will go directly to a general surgical nursing floor after surgery to recover. Your diet will be slowly advanced as tolerated. Most people will be walking immediately after the operation. Expect to spend at least a week in the hospital, depending on your overall recovery.If you have certain medical conditions or a complex case, you may be admitted to the ICU after surgery.
After discharge from the hospital, most people can return directly home to continue recovery. Most people are able to return to their usual activities four to six weeks after surgery.
What is Splenectomy
A splenectomy is surgery to remove the entire spleen, a delicate, fist-sized organ that sits under the left rib cage near the stomach. The spleen is an important part of the body's defense (immune) system. It contains special white blood cells that destroy bacteria and help the body fight infections when you are sick. It also helps remove, or filter, old red blood cells from the body's circulation.
Why is it done?
Spleen is removed in case of an injury that damages the organ, causing its covering to break open, or rupture. A ruptured spleen can lead to life-threatening internal bleeding.
A splenectomy may also be recommended in case of cancer involving the spleen or certain diseases that affect blood cells. Certain conditions can cause the spleen to swell, making the organ more fragile and susceptible to rupture. In some cases, an illness, such as sickle cell disease, can cause the spleen to shrivel up and stop functioning. This is called an auto-splenectomy.
The most common disease-related reason for a spleen removal is a blood disorder called idiopathic thrombocytopenic purpura (ITP). This is an autoimmune condition in which antibodies target blood platelets. The spleen is involved in making these antibodies and removing the platelets from the blood. Other common reasons a person may need a spleen removal include:
- Blood disorders
- Blood vessel problems
- Cancer
- Cyst or abscess (collection of pus) in the spleen
What are the risks associated with LC
Splenectomy is generally a safe procedure. But as with any surgery, splenectomy carries the potential risk of complications, including:
- Bleeding
- Blood clots
- Infection
- Injury to nearby organs, including your stomach, pancreas and colon
You can live without a spleen. But because the spleen plays a crucial role in the body's ability to fight off bacteria, living without the organ makes you more likely to develop infections. You may be recommended to receive vaccines & to take preventive antibiotics, especially if you have other conditions that increase your risk of serious infections.
How it is it done
You will be given general anesthesia a few minutes before surgery so you are asleep and do not feel pain. Laparoscopic splenectomy is done using an instrument called a laparoscope. This is a slender tool with a light and camera on the end. Three or four small cuts in the abdomen are made and the laparoscope is inserted through one of them. This allows us to look into the abdominal area and locate the spleen. Different medical instruments are passed through the other openings. One of them is used to deliver carbon dioxide gas into the abdominal area, which pushes nearby organs out of the way and gives more room to work. The spleen is disconnected from surrounding structures and the body's blood supply, and then removed through the largest surgical opening. The surgical openings are closed using stitches or sutures.
What to expect from procedure
After surgery, you will stay in the hospital for a while to monitor your condition. You will receive fluids through a vein, called an intravenous (IV) line, and pain medications to ease any discomfort. Those who have a laparoscopic splenectomy are usually sent home in less than a week. It will take about four to six weeks to recover from the procedure. Activities have to be limited for the next 4-6 weeks and it will be suggested to you on the lifestyle changes required.
What is trauma surgery
What are the risks associated with it
How it is it done
What to expect from procedure
What is Shunt surgeries for portal hypertension
Portal hypertension is an increase in the blood pressure within a system of veins called the portal venous system. Veins coming from the stomach, intestine, spleen, and pancreas merge into the portal vein, which then branches into smaller vessels and travels through the liver. Portal hypertension is an increase in the blood pressure within a system of veins called the portal venous system. Veins coming from the stomach, intestine, spleen, and pancreas merge into the portal vein, which then branches into smaller vessels and travels through the liver. Decompression procedures to treat portal hypertension are:
- Transjugular intrahepatic portosystemic shunt (TIPS): This procedure involves placing a stent (a tubular device) in the middle of the liver. The stent connects the hepatic vein with the portal vein, which reroutes blood flow in the liver and helps relieve pressure in abnormal veins.
- Distal splenorenal shunt (DSRS): Less common these days, this procedure connects the vein from your spleen to the vein from the left kidney in order to reduce pressure in the varices and control bleeding.
Why is it done?
If endoscopic therapy, drug therapy, and/or dietary changes don't successfully control variceal bleeding or ascites (a buildup of fluid in your belly), TIPS and DSRS are the options.
What are the risks associated with it
Shunt narrowing or blockage can occur within the first year after the TIPS & DSRS procedure. The signs of a blockage include increased ascites (accumulation of fluid in the abdomen) and re-bleeding. This condition can be treated. Encephalopathy, or abnormal functioning of the brain, can occur with severe liver disease. This condition can be treated with medications, diet, or by making the shunt inaccessible.
How it is it done
During the TIPS procedure, a radiologist makes a tunnel through the liver with a needle, connecting the portal vein to one of the hepatic veins (veins connected to the liver). A metal stent is placed in this tunnel to keep it open. The procedure reroutes blood flow in the liver and reduces pressure in abnormal veins, not only in the stomach and esophagus, but also in the bowel and the liver.The radiologist performs the procedure within the vessels under X-ray guidance. The process lasts one to three hours, but you should expect to stay in the hospital overnight after the procedure.
The DSRS is a surgical procedure during which the vein from the spleen (called the splenic vein) is detached from the portal vein and attached to the left kidney (renal) vein. This surgery selectively reduces the pressure in the varices and controls the bleeding associated with portal hypertension. It is usually performed only in patients with good liver function.
What to expect from procedure
The TIPS & DSRS procedure controls bleeding immediately in more than 90% of patients with portal hypertension. However, in about 20% of patients, the shunt may narrow, causing varices to re-bleed at a later time.The DSRS procedure provides good long-term control of bleeding in many people with portal hypertension.
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