Pancreatic & Liver Procedures
Pancreatic resection is the removal of part or all of the pancreas. The pancreas is a glandular organ located behind the stomach which produces enzymes to aid digestion and hormones to help regulate blood sugar. The pancreas is, therefore, part of the digestive tract and also part of the endocrine system. Since the functions of the pancreas are so complex and important, the goal of pancreatic resection is to remove all traces disease while preserving as much of the pancreas, bile duct and duodenum as possible.
Reasons for Pancreatic Resection
There are a number of reasons for removing all or part of the pancreas. Depending on the reason for the surgery and the location of the problem, the outcome of the surgery may vary a great deal. Some of the most common reasons for pancreatic resection are:
- Pancreatic cancer
- Severe or chronic pancreatitis
- Severe trauma
- Cancer of the bile duct or duodenum
- Severe hyperinsulinemic hypoglycemia
The Pancreatic Resection Procedure
Pancreatic resection, depending on the nature of the problem, may be done laparoscopically or as an open procedure. When part of the duodenum has to be removed along with the pancreas, the surgery is called a pancreaticoduodenectomy. In some cases, particularly where there is advanced malignancy, the bile duct, duodenum and part of the stomach may also be removed in an operation called a Whipple procedure. This is a rare and technically difficult procedure in which the most experienced surgeons achieve the best outcomes.
Pancreatic cancer develops in the pancreas, a pear-shaped gland approximately six inches long. Located in the abdomen, between the stomach and the spine, the pancreas has two different kinds of glands, the exocrine and the endocrine. The exocrine helps with digestion; the endocrine produces hormones to balance the amount of sugar in the blood. Pancreatic cancer is one of the leading causes of cancer death in the United States because it usually spreads rapidly and is not easy to detect. It develops as a result of a genetic mutation within the pancreatic cells, which causes them to grow uncontrollably and, eventually, form a tumor. The majority of tumors originate in the exocrine gland.
Treatment of Pancreatic Cancer
Once diagnosed, treatment to eliminate the cancer or prevent it from spreading should begin immediately. The type of treatment depends on the stage of the disease. Unfortunately, pancreatic cancer can only be cured if it is found at an early stage, before it has spread, and the entire tumor can be surgically removed. In addition to surgery, types of treatment may include radiation therapy, chemotherapy and targeted-drug use.
New methods are currently being tested to effectively treat pancreatic cancer, and improve the prognosis for those with this life-threatening disease.
Biliopancreatic diversion is a weight loss procedure that is performed to make the stomach smaller and cause a reduced absorption of calories.
This procedure helps to create a metabolic effect that allows most patients to lose 75 to 80 percent of their excess weight.
The Biliopancreatic Diversion Procedure
Biliopancreatic diversion can be performed either as a laparoscopic or traditional open procedure depending on the overall health of the patient. It can be performed with or without a duodenal switch, which involves attaching the remaining portion of the stomach to the duodenum, or upper part of the small intestine. This optional part of the procedure helps to bypass even more of the intestine, allowing for the absorption of even fewer calories.
A pancreatic pseudocyst is a sac of fluid that has collected on or around the pancreas. The sac is usually composed of pancreatic fluid that has leaked out of the pancreatic duct, scar tissue, and blood.
A pancreatic pseudocyst most often develops after an attack of acute or chronic pancreatitis or as a result of abdominal trauma.
Treatment of a Pancreatic Pseudocyst
Most pancreatic pseudocysts present no symptoms and go away on their own. Surgical treatment is only necessary for a pancreatic pseudocyst that remains for more than a month and have a diameter of more than 5 centimeters. Other treatment options may include the following:
- CT-guided needle drainage
- Laparoscopic surgical drainage
- Endoscopic drainage
A liver biopsy is a diagnostic procedure used to examine liver tissue and determine the cause of any abnormalities. This procedure is often performed after another test, such as a blood test or imaging test, indicates a problem with the liver. A liver biopsy can diagnose many problems, including cirrhosis, hepatitis B or C, and liver cancer. Results from a liver biopsy are available within a few days to several weeks.
Types of Liver Biopsy
There are several ways a biopsy may be performed; all involve the use of a needle to extract tissue samples, and all take a relatively short time, usually less than an hour. The patient is sedated and/or anesthetized and pain medication is administered as necessary. In all of these procedures, several samples of liver tissue may be removed.
Percutaneous Liver Biopsy
In this commonly used technique, a hollow needle is inserted through the abdominal wall to extract a small piece of tissue. Ultrasound, a CT scan or other imaging techniques are often used by the surgeon for guidance during the procedure.
Transvenous Liver Biopsy
This type of biopsy is performed when there is a complicating factor, such as excess fluid in the abdomen, called ascites, or when the patient’s blood clots slowly. During a transvenous liver biopsy, an incision is made into the neck, and a hollow tube, or sheath, is inserted into the jugular vein. The physician threads the sheath through the jugular vein, past the heart, and into one of the hepatic veins. Contrast dye is added so that the blood vessels and the sheath can be easily located by the doctor performing the procedure.
Laparoscopic Liver Biopsy
Laparoscopic biopsies are performed when multiple areas of the liver must be examined, or when there is a risk of spreading cancer or infection. During such a biopsy, several small incisions, rather than one large one, are made, and the doctor works with special small tools, including a miniature lighted camera.
The liver is the largest organ in the body. It performs many important functions, including breaking down and storing nutrients, secreting bile into the intestines to help in nutrient absorption, and removing toxic waste. The liver also produces clotting factors that keep cuts or injuries from bleeding excessively.
Although the specific cause of liver tumors is unknown, it is believed that they develop when the DNA of cells in the liver change, causing the cells to grow uncontrollably and eventually form a tumor. These tumors can be either benign or malignant. Primary liver cancer refers only to cancer that originates in the liver.
Types of Malignant Liver Tumors
Malignant liver tumors can be fatal, and should be treated as soon as possible to address their symptoms and prevent them from spreading to other areas of the body. Types of malignant liver tumors include:
- Hepatocellular Carcinoma
- Angiosarcoma and Hemangiosarcoma
Types of Benign Liver Tumors
Benign liver tumors are common. Usually asymptomatic, they are most often detected during imaging tests for other conditions. Because they do not spread to other areas of the body, they usually do not pose a serious health risk. If necessary, they can be removed by surgery.
- Focal Nodular Hyperplasia
- Hepatocellular Adenoma
The liver is the largest organ in the body. It performs many important functions, including breaking down and storing nutrients; secreting bile into the gallbladder to help in nutrient absorption; and removing toxic waste. It also makes clotting factors that keep cuts or injuries from bleeding excessively. One of the world’s most common cancers, most cases are found in developing countries in Africa and East Asia. Men are more likely than women to be diagnosed with liver cancer.
Because there are many different types of cells in the liver, different types of tumors can form there; they can be benign or malignant. Hemangiomas and hepatic adenomas are examples of benign liver tumors, while hepatocellular carcinoma, angiosarcoma and hemangiosarcoma are examples of malignant ones. Cancers that migrate to the liver from other organs are called liver metastases.
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