Preservation of pancreatic tissue is an important goal during surgery for biliary and pancreatic diseases. The Whipple procedure is the standard of care and the procedure of choice for many malignant conditions of the pancreas , duodenum and the bile duct. It is also frequently performed for benign disorders that affects these organs. While in some patients, the extent and the nature of the disease may require a Whipple surgery, in some others, alternate procedure that preserves some of the tissues removed during the standard procedure may be an option. Some of these procedures include:
1) Duodenum preserving pancreatic head resection : This is offered to patients with chronic pancreatitis and non cancerous disorders of the head of the pancreas such as cystic neoplasm or small islet cell tumors which would otherwise require a Whipple operation. As the name suggests, this procedure preserves the duodenum. The head of the pancreas is removed. Postoperatively it is seen that the patients have rapid return of bowel function and less GI complications.
2) Central pancreatectomy- : This procedure is indicated for patients who have low grade malignant or benign tumors in the middle part of the pancreas which is also called the neck. Often this may require an extended Whipple procedure and a large portion of the normal pancreas has to be removed along with the tumor, but with the above mentioned alternative specialized technique, only the tumorous portion of the neck of the pancreas is removed.
3) Enucleation of pancreatic islet cell tumors : Insulinomas and gastrinomas are small functional pancreatic surface tumors. They have a lining around them that seperates them from the pancreas. During enucleation these tumors are shelled out from the pancreas without removing any pancreatic tissue. It is done laparoscopically.
4) Spleen preserving distal pancreatectomy : ThIs procedure is indicated for benign disorders or low grade malignancy of the last part or the tail of the pancreas. The purpose is to spare the spleen. Normally a standard distal pancreatectomy with spleen removal is done when in these cases there is often no indication for a splenectomy.
5) Wide resection of Ampulla of vater : For ampullary polyps or some benign disorders of the ampulla such as villous adenomas, the Whipple operation is offered when it is best to do a local resection of the ampulla . In this procedure the ampulla is widely removed and the cut ends of the bile duct and pancreatic duct is reimplanted into the duodenum.
6) Isolated resection of the third and fourth portion of the duodenum : This is also performed to avoid a Whipple surgery for tumors on the third and fourth portion of the duodenum. In this surgery only the third and fourth portion of the duodenum is removed and the cut ends of the intestine are then sutured together.
Pancreas plays an important role in the digestion of food and in the regulation of blood sugar. Loss of pancreatic tissue after surgery increases the risk of developing diabetes and malabsorption of food. It is therefore, very important that we try and preserve this vital organ as much and as far as possible even when there is a need for surgery.