Operations on the pancreas
Author: abdominal surgeon Denisov M.М.
From the point of view of surgery, the structure of the pancreas is very unfavorable. This is due to the large number of blood vessels, excretory ducts and insignificant contents of connective tissue. In view of this, operative interventions on the pancreas are characterized by severe bleeding, inconsistent sutures and a high risk of postoperative complications.
The pancreas weighs 65-80 grams, is located in the abdominal cavity and is surrounded by important formations (abdominal aorta, celiac artery, superior mesenteric artery, inferior vena cava, median artery of the colon, spleen gates, common bile duct). Drawing a conclusion from all the above features of this body, it becomes clear that carrying out operations on the pancreas is characterized by a high level of complexity and requires special skill and skill of the surgeon.
It is advisable to note that in this case complete removal of the organ is possible. Since the main function of the gland is to produce insulin, then after removal of the pancreas, substitution therapy is performed.
Access and exposure of the pancreas
If an operation is performed that involves the complete or partial removal of the organ, the best approach is to open the abdominal cavity with an upper transverse incision. It is thanks to this cut that better access to the pancreas is provided, and the postoperative period is characterized by fewer complaints and complications. A number of surgeons use the upper median laparotomy (longitudinal section from the xiphoid process to the navel) to open the abdominal cavity, an incision in the form of an inverted T (characterized by a combination of an upper median laparotomy with a transverse incision at the navel level).
After the abdominal opening has been performed, the surgeon proceeds to isolate the pancreas, which consists of dissection of the ligaments and mesentery of the intestine, the application of ligatures to nearby vessels.
Slices with designations represent a separate access to the pancreas.
Surgical treatment of fistula of the pancreas.
If treatment of the pancreas with folk remedies is unsuccessful, then it is necessary to resort to a surgical operation. Fistula of the pancreas occurs after the rupture of the pancreas cyst, any surgical interventions on this organ, trauma, taking a piece of organ for biopsy.
For surgical treatment, access is provided by longitudinal or transverse laparotomy, and the surgeon tries to make it so that the fistula localization coincides with the middle section.
Without damaging the fistulous course, produce its excision at the base. Often, if the fistulous course is well developed, then it is sewn into the stomach. Thus, the pancreatic juice does not go out, but directly into the stomach.
In the event that the fistula does not go to the head of the pancreas, but to its body or tail, then a partial removal of the pancreas along with the fist formed.
Surgical treatment of acute pancreatitis.
The main indication for surgical intervention in acute pancreatitis is the lack of positive dynamics within 24 hours of dynamic observation under the condition of conservative treatment. If there is a lack of confidence in the diagnosis, the surgeon resorts to diagnostic laparotomy. Depending on the data obtained during this manipulation, the choice of surgical intervention is made:
1. If there is pancreatic edema, then no surgical interventions are performed, and the patient undergoes active conservative therapy.
If the tension of the bile duct is observed against the background of the edema of the gland, then drainage is performed.
2. When hemorrhagic and necrotic areas are found on the surface of the pancreas, the main method of surgery is radical necrectomy (i.e., removal of the pancreas site in the redistribution of healthy tissues).
In case necrotic lesion of the whole gland is observed, total pancreatectomy (complete removal of the pancreas) is performed. Read more about pancreatic necrosis here.
Pancreatectomy for hemorrhagic pancreatitis is a rather difficult intervention, since the operation is accompanied by significant bleeding, therefore it is performed only when absolutely necessary in special medical institutions.
Surgical treatment of pancreatic cysts.
Cysts of the pancreas - a benign formation, often occur against the background of acute pancreatitis, injuries, as well as for unknown reasons. The wall of the cyst is represented by an inflammatory tissue that is the wall of nearby organs and formations, the contents of the cyst cavity is represented by liquid and pieces of necrotic tissue in it. There are formations in any part of the pancreas, often in the body and tail area of the organ, reaching large sizes. If the cysts are large, surgical intervention consists in applying an anastomosis, in which a message is created between the loop of the intestine and the cyst itself, in order to divert the contents of the cyst. If the cysts are small in size, the best method of treatment is their radical excision, which removes the corresponding parts of the pancreas.
Surgical treatment of chronic pancreatitis.
Establish a diagnosis of chronic pancreatitis is not easy, because this pathology is concealed under the guise of many diseases, for example polyposis of the stomach, hypertrophic gastritis, malabsorption syndrome. Operative treatment is conducted only after the clarified cause of this disease. The operation on the biliary tract is performed if the common bile duct is involved in the pathological process. In this case, the plastic of the sphincter of Oddi is performed. Also, caudal pancreatomyunostomy and longitudinal pancreaticunostomy are performed. Pancreatojunostomy is to remove the tail of the pancreas with the application of anastomosis with the transverse colon. While pancreatic yoynostomy is performed by applying an anastomosis between the pancreatic duct dissected in the longitudinal direction and the loop of the transverse colon. This type of operation has significant advantages in comparison with partial or complete removal of the gland:
A. Thanks to this method, it is possible to get pancreatic juice directly into the intestine,
B. There is a disappearance of pain associated with chronic pancreatitis,
B. The remaining intact tissue is not sacrificed,
D. The occlusion and stenosis of the duct of the pancreas is completely eliminated.
Removal of pancreatic tissue
Surgeons resort to the operations of this group in the event that the tissue of the pancreas is irreversibly damaged in a significant gap.
The following types of operations are applied:
1. Left-sided hemipancreatectomy (removal of the tail and body of the pancreas). This type of operation does not lead to the development of diabetes mellitus,
2. Total pancreatectomy (complete organ removal). This surgical intervention develops diabetes mellitus, which can be maintained in a normal state by daily intake of insulin, the dosage in this case is selected individually for each patient.
Surgical treatment with insulin
Insulinoma is a beta-cell adenoma. It is a benign pancreas formation, more often localized in the body and tail area. A tumor can be either single or multiple. The peculiarity of education is the production of insulin, which is why the clinic of hypoglycemia (weakness, trembling, loss of consciousness, increased sweating) is characteristic.
The main method of surgical treatment is enucleation (i.e., vyluschivanie) of benign adenoma. Since the dissected tissue of the gland bleeds heavily, the incision in the case of vyluschii must be carried out strictly according to the volume of the tumor. An important factor is the fact that when pressure is applied to the insulin, a large amount of insulin is released. This phenomenon entails severe consequences, which are based on a sharp decrease in glucose in the blood. Therefore, the surgeon must be particularly careful when carrying out this type of operation.
Author: doctor Derjushev A.N.
Inflammation of the pancreas - chronic pancreatitis develops due to delayed excretion and intra-organ activation of pancreatic enzymes. That is, in other words, the enzymes produced by the pancreas and which must be involved in the dissolution of food proteins are activated in the gland itself and begin to dissolve it! In medicine, this process is called autolysis - self-dissolution.
Author: abdominal surgeon Denisov M.М.
In 10% of cases against the background of acute pancreatitis, necrosis of the pancreas develops. The destruction of the fiber surrounding the pancreas, its lobules, and pancreatic cells is caused by the action of lipase (the enzyme of the pancreas).
Author: ambulance doctor Deryushev A.N.
The clinic of such a terrible disease as an abscess of the pancreas, was first described by Doctor V. Portal in 1804. Since then, almost nothing has changed. The abscess itself is a purulent inflammation, which is accompanied by the melting of tissues, with the formation of a cavity, which is usually filled with purulent contents.