Whipple surgerySurgery - one of the main ways of treating this disease. operation type is determined based on the amount and size of the tumor, the presence of secondary foci in the body, the possibility of complete removal of malignancy.

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The operational methods of treatment of pancreatic cancer are very complex. The surgeon should have a high level of skill and experience to achieve quality results. Israeli clinic can offer services of highly qualified and experienced professionals. The highest chance of successful treatment provides 100% removal of the tumor. It also requires modern medical equipment - the use of powerful microscopes.

Operation in pancreatic cancer aims mainly two purposes - removal of malignancy in full or reduction of pain and other symptoms of the disease.

Only about 10% of cases the tumor is localized within the boundaries of the pancreas, when diagnosed with cancer.

Even using advanced diagnostics, Doctors are not always able to accurately determine the stage of the disease, without resorting to surgery. On the basis of imaging tests is that the specialists come to the conclusion about the operability of the tumor. However, during surgery it appears that the formation of malignant inoperable, there are secondary foci.

If the diagnosis of pancreatic cancer results indicate that the tumor can not be resected, palliative surgery may be performed. They are aimed at relieving pain, reducing the signs of the disease.

The Israeli hospitals following operations are carried out in pancreatic cancer. Also can be applied other methods of treatment before or after surgery.

Whipple's operation (pancreatoduodenal resection) in Israel

Whipple surgery is most often carried out with this ailment. It is used for removal of malignancy in the head of pancreas or pancreatic duct in the hole. During surgery performed resection:

  • the head of the pancreas with an initial portion of the small intestine (duodenum);
  • gallbladder;
  • segment of the common bile duct;
  • pylorus (pylorus);
  • lymph nodes near the head of the pancreas.

In some cases, surgery may be performed a modified Whipple's, it does not affect the normal function of the stomach.

Indications pancreatoduodenectomy

This type of operation is carried out with the purpose of treating cancer afflicting different organs - the pancreas, bile ducts, gall bladder, small intestine.

How is pancreatoduodenal resection?

This is a very serious operation which is performed under general anesthesia. It lasts for six to twelve hours. The surgeon makes an incision in the abdominal cavity, examines the authorities to remove the tumor without damaging vital structures. If possible, the doctor resected malignant tumor with part of the healthy tissue (the so-called surgical margins). Removed tissues are sent to a laboratory, where a pathologist examines them determines stage of disease, the presence of cancer cells in a surgical margin. Based on the results of the pathologist report, the doctor will decide which treatment is further required.

During surgery, the surgeon removes Whipple head of the pancreas, the gallbladder, the initial small intestine (duodenum), pylorus, common bile duct segment surrounding lymph nodes. After resection of these organs it connects the stomach to the jejunum - creates gastroeteroanastomoz. The remaining segment of the common bile duct and docks with the jejunum to bile and pancreatic juices are received therein. They will help neutralize stomach acid and reduce the risk of ulcers in this area.

Modified operation Whipple

Unlike the standard pancreatoduodenectomy in modified preserved pylorus - the pylorus. This type of surgery does not affect the stomach, it continues to function normally. After modifying the operation there is no power problems as after standard surgery.

Modified pancreatoduodenectomy recommend:

  • If a malignancy in the pancreatic head is not big and bulky.
  • When the tumor has not grown into the beginning of the small intestine.
  • There are no cancer cells in the lymph nodes around the pylorus.

After pancreatoduodenectomy

After surgery, the patient remains in the hospital for seven to ten days. I am appointed painkillers intravenously. It can be used an epidural or patient controlled anelgeziya. Also installed drip through which the body receives intravenous nutrition and fluid until the patient will not be able to eat and drink on their own. catheter will be placed for diverting urine from the body. After a few days they will be removed. The recovery process takes about a month. It will take about three months, until completely restore the digestive system.

After partial removal of the pancreas, the remainder can not produce enough insulin to control blood sugar levels. Insulin injections are administered before until the body does not recover after the operation and will not start again synthesize insulin. You may need to intake of digestive enzymes to help the body break down and absorb fats and proteins.

Specific recommendations for children

Whipple operation is often used for the treatment of pancreatic tumors in children (adenocarcinoma, for example). Preparation may include anxiety reduction, the strengthening of cooperation, helping the child to develop self-management skills, and depends on the age of the child. Doctors and parents help prepare him, explaining to him what happens.

distal pancreatectomy

This operation is performed when the malignancy is in the body and tail of the gland. During surgery, the surgeon removes the prostate tail or the tail, the body segment and the nearest lymph nodes. If the pathological process struck spleen or blood vessels supplying it with blood, the spleen is removed. The head of the pancreas joins the initial section of the small intestine.

total pancreatectomy

Total pancreatectomy is performed rarely. Doctors consider this option of surgery if the cancer has spread throughout the gland, or when it can not be safely connected to the small intestine. During total pancreatectomy surgeon removes completely the pancreas, the initial small intestine, pylorus, segment of the common bile duct, gallbladder, spleen, and sometimes disposed adjacent lymph nodes. After that the doctor connects the stomach to the jejunum, creating a gastrojejunostomy. The remaining segment of the common bile duct is also connected with the jejunum.

Because the pancreas is removed, patients develop diabetes, there is a need in the reception of insulin. Diabetes is often difficult to control.

Also, the pancreas produces enzymes that help digest food. After resection there is a need to accept enzymes rest of his life.

Palliative surgery

To her resorted to relieve the symptoms of locally advanced, metastaticor recurrent pancreatic cancer. Neoplasms in the head glands often block the common bile duct or the start of the small intestine. Palliative surgery is performed to remove the blockage.

stent

stent placement - a process which often resorted to remove the blockage caused by the tumor. A stent is a thin, hollow tube typically made of metal. It is placed in the bile duct, duct holding open, exerting pressure on the inner side wall. After that, the bile flows into the small intestine.

The stent is typically set during endoscopic retrograde cholangiopancreatography (ERCP). Sometimes doctors prefer the so-called percutaneous method, when a cut through the skin to place the stent in the bile duct. After this procedure, the bile flows into the bag, which is located outside the body.

The stent should be changed every 3-4 months or even more frequently. New types of stents wider, it has a great potential. They are used to try to keep the duct open.

bypass surgery

Installing an endoscopic procedure the stent can replace bypass surgery, which reduces blocking caused neoplasm of the pancreas in a number of cases. Depending on the sealing seats are various bypass surgery.

  1. Holedohoeyunostomiya involves joining the common bile duct to the jejunum. This procedure is bypass surgery can be performed laparoscopically.
  2. Hepaticojejunostomy - an operation, during which the common hepatic duct is connected to the jejunum.
  3. Gastric bypass surgery or gastrojejunostomy - the type of shunt, when the stomach is connected directly to the jejunum. Sometimes this procedure is used to avoid a second surgery if there is a risk that the duodenum is locked, when the disease progresses.

Possible side effects after pancreatoduodenectomy (and other operations in pancreatic cancer)

Whipple surgery carries a fairly high risk of complications. Approximately 30-50% of people who have undergone this surgery, undesirable effects observed. It is important to tell your doctor if you experience any of these side effects.

  1. The pain often occurs after operation due to tissue injury. For its control using analgesics for several days. Need a certain time before the pain goes, it depends on the healing process and the pain threshold level.
  2. The risk of infection. The wound drainage can be placed to remove excess liquid and to accelerate the healing process. Doctors prescribe antibiotics to prevent or treat infection. This is a temporary unwanted effects that may occur after any kind of surgery.
  3. The bleeding can be due to problems with blood clotting, for example, or the result of non-insulated during the operation of the blood vessel. A small amount of blood can be separated to collect drainage, which is seen as the norm.
  4. Leak anastomosis. Sometimes there is leakage of bile, stomach acid and pancreatic juice from the newly united bodies after removal of the affected tissue. The physician may prescribe octreotide (sandostatin) to reduce the amount of pancreatic juice, which will provide a more rapid process of anastomotic healing.
  5. Delayed gastric emptying is a condition in which food remains in the stomach longer than usual. This occurs when there is a partial paralysis of the body as a result of nerve damage during surgery. Delayed gastric emptying can cause nausea, vomiting. After 4-12 weeks of symptom goes away. It can be applied via a tube feeding to ensure adequate nutrition. This symptom is most common after a modified Whipple surgery than after standard.
  6. Dumping syndrome is a group of symptoms that occur when food moves too quickly from the stomach into the small intestine. It can also be caused by rapid gastric emptying. Often observed after standard Whipple operation, after surgery the gatekeeper and the duodenum. Symptoms of dumping syndrome include sweating, cramps, bloating, diarrhea. Doctors in Israeli clinic methods offer the patient manage this condition - changes in diet, medication or surgery.
  7. Problems with the power supply may occur after pancreatoduodenectomy when there is a lack of digestive pancreatic enzymes, juices and bile. This leads to poor appetite, decreased absorption of fat (body does not receive a sufficient amount of fat-soluble vitamins - A, D, E and K), diarrhea, bloating and indigestion. Doctors in Israel will advise how to maintain a healthy diet after surgery. It is possible that the patient will require acceptance of digestive enzymes. There will also be recommended more private meal, the use of low-fat products, designated anti-nausea medications, vitamin supplements. If you have serious problems, you may need the power from the probe, so that the body received sufficient amounts of nutrients.

The Israeli medical institutions for the patient develop personalized treatment programs, when put at the forefront, not only disease, but also the man himself. Patients and their exceptional care is provided by relatives.

Since the patient has a team of experts -. Gastroenterologists, oncologists, radiation therapists, pathologists, radiologists, physicians palliative care nurses, and others held regular discussions of treatment and its results, consider all the available approaches to therapy that provides a combination of treatments is best suited for this, particular case. Offers the most advanced methods of treatment of the possible, that supports the quality of life during treatment.

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