Pancreatic Surgery encompasses a wide variety of surgical procedures concerning the pancreas (a gland located behind the stomach just below the liver). Disorders of the pancreas can be divided into those caused by tumors (benign or malignant) and those caused by inflammation (acute or chronic).
The majority of the surgical procedures performed on the pancrease involve resection (removal) of the portion that is involved. Prior to the operation, the patients undergo testing and are evaluated by the multidisciplinary team of physicians. The management approaches to acute and chronic pancreatitis are different, and may not necessarily involve surgical intervention. Often excellent results can be achieved through medical management.
Our surgeons have over 50 years of combined experience dealing with surgery of the pancreas. We serve as a major referral center for the State of Texas, as well as surrounding states. Our patients have come from all over the country. Multiple studies have identified that best outcomes are achieved by "high-volume" centers. Our center serves as one of the busiest in Texas.
Most malignant tumors of the pancreas are of the type called adenocarcinoma comprising up to 85% of all cancerous tumors in this organ. Surgical removal of the tumor is recommended in these patients and provides the best option for long term survival. Surgery for pancreatic cancer is a highly specialized operation and should be evaluated by a surgeon who is highly experienced and trained in treating this disease.
The Whipple procedure is the most common procedure performed on the pancreas at our institution. In this operation, the head of the pancreas is removed, along with some attached structures including the distal stomach, bile duct, and a portion of bowel. These areas are in direct proximity to each other and share blood supply. After the specimen is sent to pathology, these areas are meticulously reconstructed in a series of three delicate connections.
For some patients, vascular reconstruction is necessary to deal with a tumor that might have grown into the superior mesenteric vein or artery. In these situations, we use our expertise from the liver transplant surgery to help remove and reconstruct delicate blood vessels using your own vein from either a superficial neck or leg vein. These surgeries are more advanced and highly technical, but offer a chance to those patients that might not be considered surgical candidates at other centers. Not all patients are candidates for this procedure, but a careful evaluation by our physicians will help guide this consideration.
Most Whipple Surgeries last two to four hours. Extra time is needed for those surgeries involving blood vessels. Recovery in the hospital last approximately six to nine days, and is mostly spent awaiting for bowel function to return. Complications can involve infections and delayed stomach emptying, almost of which all can be managed medically. We are proud to report leak rate approaching zero percent.
Laparoscopic Distal Pancreatectomy – For tumors involving the distal part of the pancreas, usually no other major organs (except spleen) are removed. These operations are performed using small key hole incisions with one small incision in the middle to remove the tumor. Recovery from this surgery is much quicker, with an average hospital stay of 3 days.
We also treat:
Gall Bladder / Bile Duct Sugery
Cholangiocarcinoma is a cancer of the bile ducts which drain bile from the liver into the small intestine.
Removal of the gallbladder can be performed by most general surgeons in a laparoscopic or open approach. Most patients who come to CTRC for cholecystectomy have a preexisting disease that makes this simple procedure more complex, such as liver cirrhosis. With our particular knowledge of complex patients, we can safely remove diseased gallbladders utilizing specialized techniques to control blood loss. Most healthy patients with diseased gallbladders can be removed in as little as 15 minutes, but patients with portal hypertension or diseases of the liver may stay longer.
The Nanoknife is a new technology recently made available to the patients of Central and South Texas. Nanoknife uses controlled electrical pulses to make "nano-sized" pores in the cell membranes of tumors. This irreversible poration leads to cell death via apoptosis. Healthy surrounding cells regenerate via the guidance of good, natural progenitor cells, while tumor cells cannot remodel. This treatment is still in the experimental phase, but is a good treatment option for some tumors of the liver and pancreas and tumors that are close to major vascular structures. The first pancreas patient in Texas to be treated with the Nanoknife was done at CTRC in 2011. Since then, we have treated patients with liver and a variety of other tumors. This can be done in the operating room for some patients, but may also be done as an outpatient setting in our Radiology Department, on a case by case evaluation.
Numerous studies have shown that the unnecessary use of blood during or after surgery leads to an increased infection rate, increased hospitalization rate and higher recurrence of cancer. We minimize the use of blood products during surgery as much as safely possible. Utilizing techniques adapted from blood conservation techniques used on our Jehovah's Witness population, we can reduce the risk of blood transfusion problems tremendously. Modeling our program after the University of Southern California Bloodless Surgery Protocols, bloodless surgery candidates, such as Jehovah's Witness patients, will visit preoperatively with one of our specialists to optimize blood counts prior to surgery. Some patients may need iron supplementation and epogen. During surgery, blood may be saved via a technique known as Autologus Normovolemic Hemodilution (ANH.) In this procedure, blood is removed from the body and stored in specialized blood storage containers per a special Blood Bank protocol. Blood volume is replaced with fluids such as an albumin solution or normal saline. When needed, or at the conculsion of the case, the blood is returned to the body via the same line. In this manner the blood that is stored in the holding containers never leaves the body, but is always in contact with the body through the line.
Pediatric Surgery / Transplant Surgery
For several years, CTRC has served as a tertiary referral center for major liver and pancreas diseases in children. Our patients have come from Texas and the surrounding region. Usually, these patients have been referred from Pediatric Surgeons specifically for the technical expertise of our surgeons. Valeria Garcia is a patient from South Texas. Two separate teams of surgeons operated on Valeria's liver tumor and were incapable of removing the tumor. As a last effort before hospice, Valeria was sent to our Center where our surgeons were able to remove the entire tumor successfully in two hour operation. Valeria went home in five days and now leads a normal life.
Our team of surgeons also perform liver transplant surgery on children at Christus Santa Rosa Children's Hospital. If you would like more information, please call (210) 704-4661 or visit the website at http://www.christussantarosachildrens.org/body.cfm?id=53