Programs : Advanced MI & Robotic Surgery
PANCREAS surgery:
- Proximal pancreatectomy (Whipple operation or Longmire)
- Central Pancreatectomy
- Distal splenopancreatectomy
- Distal pancreatecomy with spleen preservation
- Total Pancreatectomy
- Pseudocystgastrostomy
- Pseudocystjejunostomy
- Pseudocystduodenostomy
Whipple (Pancreaticoduodenectomy) Surgery.
Whipple procedure or Pancreaticoduodenectomy is a surgery done to remove the head and the neck of pancreas for:
- Tumor of the pancreas
- Tumor of the bile duct
- Chronic pancreatitis
- Tumor of duodenum
This surgery can be done either minimally invasive with Robot assist (Robotic Pancreatectomy) or open. The surgeon will make this recommendation depending on your previous surgical history and medical condition. If the surgery is done to remove a tumor in the head of pancreas it is necessary to remove the head, the duodenum, the gall baldder, part of common bile duct and sometimes part of stomach. Some times a feeding tube will be tempoarily inserted to stomach for future use. The operation may take between 4-7 hrs.
The pancreas is a gland about six inches long and two inches wide located behind the stomach. It is divided into four parts: the head (by the first part of the small intestine called duodenum), the neck, the body and the tail. The pancreas secrets hormones and enzymes. The hormones are Insulin and Glucagons which regulate blood sugar level. The enzymes help with digestion especially the fat. Surgery to remove part of the pancreas may not affect the blood sugar level. However, infrequently there is need of insulin. Often, the remaining pancreas may not make enough enzymes to digest food and may need to take a pill with meals for replacement.
Hospital Stay After surgery
Expect 5- 10 days of hospital stay depending on how the surgery is done.
If the surgery is done minimally invasively the hospital stay can be less.
Pain:
On the first day after surgery there can be severe to moderate pain. Pain is less if the surgery done minimally invasive than open surgery. Pain medication will be given either thru an epidural anesthesia which continuously infuses the medication in to spine or thru IV and pump which is controlled by the patient.
Eating:
Patients will not be able to eat or drink for a few days after surgery and will have IV for nutrition.
Activity:
Patients are expected to get out of bed sit in chair and take short walks on the first day after surgery. This is very important to prevent pneumonia and blood clots in legs.
Tubes & Drains:
After surgery the patients will have a nasogastric tube (NG) to remove the stomach contents so the intestine can recover. Patients will also have Foley catheter for urine. There may be one or two small tubes in abdomen close to the surgical incision which are attached to a bag or bulb.
Incision:
This can be one long incision in open surgery or 5 small incisions thru out abdomen if surgery is done minimally invasively
Nausea/Vomiting:
Expect some nausea and vomiting after eating. Most of the time this is because of slow recovery of gastric motility after the operation. Mainly the pylorus preserving procedure may take some days to normalize (5-7 days). Some patients may experience early satiety (sense of fullness) and /or acid reflux. This will resolve in few weeks.
Discharge Instructions
General feeling:
Some patients will feel weak and sleepy. Small tasks may be exhausting for the patients. Some times they are not able to sleep and may be depressed. These feelings are expected to resolve in 3-4 weeks. Stay active (shorter walks, small house hold chores etc) taking rest as needed. Some patients feel well couple days after surgery.
Diet:
It will take some time (4-6 weeks) to get appetite and taste back and to know which food agrees the most. Fatty foods are hard to digest and may give stomach cramps and diarrhea. Some may feel a metallic taste for a few weeks. Eat small meals 6-7 times a day. Avoid drinking when eating and separate liquids from solids by at least half hour. Some patients may be prescribed an enzyme to take with food to help digest food.
Medication:
Patients will have prescription for pain medication. Some may also have medications for constipation and enzymes to digest food. It is important to take the medications as prescribed. Some patients may temporarily be on insulin to control blood glucose.
Incision:
Patients with open surgery will have a large incision with staples across the abdomen. Patients had minimally invasive surgery will have five small incisions through out the abdomen. Slight redness around the incision is expected. Incisions can be washed gently and pat dried. Do not use any ointments on incision unless prescribed by the surgeon.
Drain:
Some patients may go home with one or two drains attached to bag or bulb. The color might be slightly pinkish to turning whitish. Empty it daily and keep a record of the amount of drainage and bring to follow up appointment for the surgeon. Drains are removed after few days to few weeks depending on the amount of drainage.
Activity:
Drive only after no pain medications are needed. Rest in between climbing stairs. Do not lift, push or pull more than 10 lbs (gallon of milk) for 6 weeks after surgery. Avoid long distance traveling for six weeks. Swimming is fine after four weeks but avoid soaking in tub for six weeks. Patients can start exercise after 6weeks. Sexual activity can be resumed when the patients feel ready.
Follow up appointment:
Patients are seen in clinic 7-10 after discharge. Call to confirm the appointment
Danger signs:
Call the surgeon/nurse for:
- Progressing abdominal pain
- Temperature of 101 or high
- Severe diarrhea
- Vomiting
- Increasing redness, drainage, swelling or bruising around incision
- Changing color or smell in drain
- Frequent urination
For any of these symptoms contact surgical team or go to the nearest emergency room
Important contact numbers:
- Remember your surgeons name
- Surgery nurse 312-355-5562 Monday thru Friday 9:00-4:00PM
- After the above hours or on weekends 312-996-6780 and ask for Surgical resident on call
Remember to keep all your appointments and follow your doctor’s recommendations
Speedy Recovery!!!
Don’t hesitate to call. Your well being is our ultimate goal.
Long Term Follow up
Patients may be referred to an oncologist for chemotherapy and or radiation after surgery depending on the pathology report. Patients will also require long term therapy to control digestive function which is evidenced by smelly, fatty or bulky stool. It is important to check weights for rapid loose. Periodically patients may require vitamin B6, B12, iron, calcium, and zinc supplementation. Some patients may also need insulin. Follow up with the surgeon annually for further recommendations and test.
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