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.

There is a longstanding and eternal debate concerning the type of fluid (crystalloid or colloid) that is most appropriate for volume resuscitation. Each fluid has its army of loyalists who passionately defend the merits of their fluid. It was believed that a major consequence of acute blood loss was an interstitial fluid deficit and that replenishing this deficit with a crystalloid fluid will reduce mortality. Thus crystalloid fluids were popularized for volume resuscitation because of their ability to add volume to the interstitial fluids. Later studies using more sensitive measures of interstitial fluid revealed that the interstitial fluid deficit in acute blood loss is small and is unlikely to play a major role in determining the outcome from acute hemorrhage. This refuted the importance of filling the interstitial compartment with crystalloids, yet its popularity did not wane.
The most convincing argument in favor of colloids for volume resuscitation is their superiority over crystalloid fluids for expanding the plasma volume. Colloid fluids will achieve a given increment in plasma volume with only one quarter to one third the volume required of crystalloids. This is an important consideration in patients with brisk bleeding or severe hypovolumia, where rapid volume resuscitation is desirable . Crystalloids can also achieve the same increment in plasma volume as colloids but then three to four times more volume is required to achieve this goal !This adds fluid to the interstitial space and can cause unwanted edema. THE PRINCIPLE EFFECT OF CRYSTALLOID INFUSIONS IS TO EXPAND FLUID VOLUME, NOT THE PLASMA VOLUME. Since the goal of fluid resuscitation is to support the intravascular volume , colloids fluids are the logical choice over crystalloids.
FILLING A BUCKET- The following example illustrates the problem with using crystalloids to expand the plasma volume. Assume that you have two buckets, each representing the intravacular compartment, and each bucket is connected by a clamped hose to an overhanging reservior that contains fluid. One reservior contains a colloid fluid in the same volume as the bucket, and the other reservior contains a crystalloid fluid in a volume that is three to four times greater than the colloid volume. Now release the clamp on each hose and empty the reserviors; both buckets will fill with fluid, but most of the crystalloid fluid will spill over on to the floor. Now ask yourself which method is better suited for filling the buckets; the colloid method with the right amount of fluid and no spillage, or the crystalloid method with too much fluid, most of which spills on to the floor.The biggest disadvantage of colloid resuscitation is the higher cost of these fluids.
Thus there is too much chatter about which type of resuscitation is most appropriate in critically ill patients , because it is unlikely that one type of fluid is best for all patients. A more logical approach is to select the type of fluid that is best designed to correct a specific problem with fluid balance. For example, crystalloid fluids are designed to fill the extracellular space(interstitial space plus intravascular space) and would be appropriate for use in patients with dehydration. Colloids on the other hand are designed to expand plasma volume and are appropriate for patients with hypovolumia due to blood loss, while albumin containing colloid fluids are appropriate for patients with hypovolumia associated with hypoalbuminemia. Tailoring fluid therapy to specific problems of fluid imbalance is the best approach to volume resuscitation !

Colon cancer is the second leading cause of cancer deaths in America, specially in older women . Being overweight increases a woman's risk of developing colon cancer but where she stores the body fat determines how long she survives with the disease. Researchers followed about 1,000 post menopausal women with colon cancer for an average of 10 years and found that the women who were heavier before diagnosis were more likely to die from the disease, earlier than their thinner peers - yet another reason to avoid obesity throughout your life. Doing so increases the chances of survival if you are diagnosed with colon cancer.
Body weight refers to how you carry extra weight. You have heard about two body shapes- the ''apple" and the" pear". Apples tend to be apple shaped carrying excess weight in their chest and abdomen and look heavier on the top. Pears tend to be pear shaped and carry excess weight in their waist , butt and thighs and look heavier on the bottom. Dozens of studies show that having an apple shaped body increases the risk of heart disease, high blood pressure, diabetes, stroke and breast cancers. Scientists looked at data for weight, body mass index, waist size and waist to hip ratio and found that carrying extra weight at the waist and hip appeared to be more a factor in colon cancer deaths than overall weight or BMI. In other words a unhealthy waist hip ratio or adipose tissue distribution towards your bottom is a very important factor in colon cancer deaths. A waist to hip ratio of 0.80 or below is considered low risk. For instance, a woman with a waist of 27 inches and a hip of 36 inches has a waist to hip ratio of 0.75.
So maintaining a healthy body weight, life long body size , maintaining a healthy waist to hip ratio is a recommendation one can give for all post menopausal women.A waist circumference more than 40 inches, in men increases their risk of colon cancer also . So make sure you are only EATING apples and pears, not LOOKING like one !