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In total pancreatectomy, the gallbladder, distal stomach, a portion of the small intestine, associated lymph nodes and in certain cases the spleen are removed in addition to the entire pancreas. [1] In recent years, the TP-IAT (Total Pancreatectomy with Islet Autotransplantation [ 2 ] [ 3 ] ) has also gained respectable traction within the ...
Pancreas. Frey's procedure is a surgical technique used in the treatment of chronic pancreatitis in which the diseased portions of the pancreas head are cored out. A lateral pancreaticojejunostomy (LRLPJ) is then performed in which a loop of the jejunum is then mobilized and attached over the exposed pancreatic duct to allow better drainage of the pancreas, including its head.
The type of surgery depends on the degree of the injury and its proximity to the mesenteric blood vessels that serve the pancreas. When injuries are not close to the mesenteric vessels, a distal pancreatectomy may be done; this procedure preserves much of the pancreas and usually avoids loss of its endocrine and exocrine functions. [4]
[20] [21] In practice, it shows similar long-term survival as a Whipple's (pancreaticoduodenectomy + hemigastrectomy), but patients benefit from improved recovery of weight after a PPPD, so this should be performed when the tumour does not involve the stomach and the lymph nodes along the gastric curvatures are not enlarged. [21]
The post-splenectomy platelet count may rise to abnormally high levels (thrombocytosis), leading to an increased risk of potentially fatal clot formation. Mild thrombocytosis may be observed after a splenectomy due to the lack of sequestering and destruction of platelets that would normally be carried out by the spleen.
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An overwhelming post-splenectomy infection (OPSI) is a rare but rapidly fatal infection occurring in individuals following removal (or permanent dysfunction) of the spleen. The infections are typically characterized by either meningitis or sepsis , and are caused by encapsulated organisms including Streptococcus pneumoniae . [ 3 ]
Splenic artery embolization is a minimally invasive procedure and, where successful, avoids splenectomy. If an individual's spleen is enlarged, as is frequent in mononucleosis, most physicians will advise against activities (such as contact sports) where injury to the abdomen could be catastrophic. [10]