Pancreas: Total Pancreatectomy

Basics

• Resection of the Entire Pancreas
• Indications:
  • Diffuse Chronic Pancreatitis with Small-Normal Ducts
  • Malignant Lesions Unable to Undergo Less Extensive Resection
  • Trauma

Technique

• Resection:
  • Entire Pancreas
  • Splenectomy – May Consider Preserving if No Suspicion of Malignancy
  • Duodenum – Still Requires Roux-en-Y for Hepaticojejunostomy
• Procedure:
  • Mobilize Duodenum, Pancreas & Spleen
  • Ligate GDA
  • Cholecystectomy & Transect CBD
  • Proximal Transection – Prepyloric or Postpyloric
  • Distal Transection – Distal to Ligament of Treitz
  • Ligate Splenic Artery (First) Then Splenic Vein
    • Preserve Left Gastric Artery (Only Remaining Supply to the Stomach)
  • Dissect Pancreas Off Portal Vein & SMA
• Reconstruction:
  • Hepaticojejunostomy (HJ)
    • At Proximal End
  • Gastrojejunostomy (GJ)
    • ≥ 20-40 cm Distally to Prevent Food Reflux into Biliary/Pancreatic Anastomoses

Islet Cell Autotransplantation

• Contraindications: Diabetic or Pancreatic Malignancy
• Fewer Diabetic Complications & Improved Quality of Life
• Procedure: Islet Cells Isolated in Lab, Infused into Portal Vein & Lodge in Liver
  • No Immunosuppression Required

Complications

• Higher Mortality Than Pancreaticoduodenectomy
• Endocrine Insufficiency – Diabetes
  • Insulin Independence Possible (29-38%) After Islet Cell Autotransplantation
• Exocrine Insufficiency – Malnutrition
  • Requires Chronic Enzyme Supplementation