Indications:
This operation is indicated for certain diseases of the pancreas, mainly pancreatic cancer, and other benign and non-benign tumours.
Procedure:
This is very major surgery. It involves removing your whole pancreas, your duodenum, a small portion of your stomach, the gall bladder and part of your bile duct, your spleen and many of the surrounding lymph nodes.
As you will not have any pancreas left after this operation, you will need life-long insulin injections to manage your diabetes. Furthermore, you will need enzyme supplementation, which involves taking a tablet before every meal to assist your digestive system to break-down and absorb some of the nutrients in the food you eat. Getting over this type of surgery is hard work. It will take time to get back to eating normally and regaining your strength.
Make sure you discuss the possible complications with your surgeon and ask all the questions you need to ask. It is important that your family members are given the chance to talk things through with the surgeon as well. The most common complications and the risk for developing them are:
- Bleeding 5% – You may have bleeding shortly after your operation because a blood vessel tie is leaking or because your blood is not clotting properly. The manner in which the bleeding episode is treated depends on what is causing it and may involve going back to the operating room for a further operation to control the bleeding site.
- Leak or fistula 10-15% – A ‘fistula’ is an opening. In this case, it means that part of the internal stitching to the digestive system has come apart or broken down. This results in some of the digestive juices and bacteria entering the abdominal cavity and resulting infection. Drains put in during the operation will be left in until the leak dries up. The leak often heals on its own. Sometimes surgery is needed to repair the leak.
- Infection 25% – Infection can develop because there is blood or tissue fluid collecting internally around the operation site or because there is internal bleeding. If you develop an internal infection, you will be given antibiotics through your drip. Abscesses or any fluid that has collected internally will need to be drained.
- Draining an abscess is usually performed by putting in a drainage tube. The needle or tube is often guided into place under X-ray or ultrasound guidance, but repeat surgery is sometimes necessary for adequate drainage.
- Chest infection is a common complication of many operations. It happens because you are not moving around enough or breathing deeply enough after your operation. What is normally coughed up stays in the lungs and becomes a focus for infection. You can help prevent this from developing by diligently doing your deep breathing exercises and becoming mobile as soon as possible. The physiotherapists and nurses will help you to mobilize early which helps the lungs to expand better and prevent lung complications.
After your consultation:
- Obtain authorization from your medical aid and book your bed for your hospital admission.
- Carefully read through pre-operative information provided.
Day before surgery:
- Do not eat/drink after 22h00, the night before your surgery, unless otherwise specified by your surgeon or anaesthetist (you should be fasting for at least 6 hours before the procedure for solids but you are allowed to take clear liquids up to two hours before your procedure).
Day of surgery:
- Arrive for admission at indicated time on ‘Code & Consent’ sheet.
- Change into theatre attire, remove all valuable belongings.
The time the procedure takes varies but is in most cases between 6-10 hours in duration.
Duration of hospital stay:
- Usually 5 – 10 days (dependent on post-operative progress)
Activities:
- Refrain from strenuous activities (incl. exercise) for at least 4 weeks post-operatively
Back to work:
- Sick leave required post-operatively is approximately 3 – 4 weeks in total
Some pain and discomfort post operatively may be expected following any operation, but the following measures are used to lessen the pain experienced:
- Warming devises in theatre as well as warm intravenous fluids.
- Intra-operative pain medication through the drip.
- Post-operative medication through the drip, please inform the nurses if you are in pain so that medication will be administered to you.
- As close to one week after discharge as possible. Please contact the rooms to schedule an appointment.
More procedures performed by Dr Jeske
A SKIN INCISION IS MADE AND THE CONTENTS OF THE ABSCESS IS DRAINED.
THE FISTULA TRACT IS IDENTIFIED AND IS OPENED ALONG ITS LENGTH, AND THE EXPOSED INSIDE OF THE TRACT IS THEN CLEANED OUT.
AN OPERATION TO REMOVE AN APPENDIX THAT IS INFLAMED/SWOLLEN/HAS RUPTURED/HAS FORMED AN ABSCESS.
THE COMMON BILE DUCT (CBD – THE MAIN TUBE CARRYING BILE FROM THE LIVER TO THE INTESTINE) IS OPENED UP. ANY GALLSTONES WITHIN THE DUCT CAUSING A BLOCKAGE CAN BE REMOVED.
PTC is a procedure performed by a radiologist (specialist X-ray doctor) who takes X-ray pictures of the bile ducts which are tubes inside the liver.
