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Pancreatic Surgery


The pancreas is a gland that lies at the back of the upper abdomen, behind the stomach. It is shaped like a tadpole; the rounded head lies attached to the duodenum (a part of the intestine that forms the outlet of the stomach), while the body and tail extend across to the left side. The pancreas produces digestive juices and aids the digestion of food. Pancreatic juice and bile mix with food in the intestine and help digestion. The pancreas also produces insulin which controls the level of sugar in the blood. Lack of insulin causes diabetes.

The operation to remove the head of the pancreas is called pancreaticoduodenectomy.

There are two types of Pancreaticoduodenectomy:

  1. The Whipple’s procedure
  2. The pylorus-preserving pancreaticoduodenectomy (PPPD). Your surgeon will decide on whether to perform a Whipple’s or PPPD operation according to the type of tumour that you have and what is seen during your operation.
charbel sandroussi whippleprocedure-8col

Whipple’s procedure

In the Whipple operation the head of the pancreas, lower quarter of the stomach, common bile duct, gallbladder, duodenum (first part of the intestines) and surrounding lymph nodes are removed. The remaining pancreas, bile duct and stomach are then rejoined to the small intestine (jejunum). This allows pancreatic juice, bile and food to flow back into the small intestine, so that digestion can proceed normally.
The operation normally takes 4-7 hours.

Distal pancreatectomy

If the problem is in the tail of the pancreas your surgeon will recommend an operation called distal pancreatectomy (removal of the tail of the pancreas). Occasionally this operation may also require the removal of your spleen. This operation can often be performed laparoscopically (keyhole surgery) and this may be offered to you.

distal pancreatectomy


Splenectomy is the removal of the spleen. The spleen helps the body’s defence against some infections. Without a spleen, your immunity to those bacteria is reduced. You will be given the following vaccinations to improve your immunity: Streptococcus pneumoniae, Haemophilus influenzae type B and Neisseria meningitides. In addition, you will need to take an antibiotic every day (usually penicillin) on a long term basis to help prevent infection.

Total pancreatectomy

This operation involves the removal of the whole pancreas. It is essentially a combination of the pancreaticoduodenectomy and the distal pancreatectomy. You will become permanently diabetic following the removal of the whole pancreas. You will be given more information about being diabetic and will also see a diabetic specialist nurse.

distal pancreatectomy

Bypass procedure

If your surgery is for suspected cancer, the tests that you have had indicate that the cancer is localised and has not spread. At the time of surgery, your surgeon may find that it is not possible or advisable to remove the growth. Such a situation arises in 1 in 10-15 cases (7-10%). This may be because the tumour has spread to another location like the liver. It could also be because the tumour has grown beyond the pancreas and become fixed to important blood vessels close by. In these circumstances, your surgeon will not remove the tumour and may carry out a bypass procedure, so that future blockage of the bile duct or stomach is prevented.

What are the benefits of surgery?

Without surgery, the average survival of patients with pancreatic cancer is less than one year, and very few survive more than 2 years. The operation aims to completely remove the cancerous growth, and give the best chance of curing the problem. The chance of cancer recurring depends on the type of tumour that you have. A successful operation can improve your chance of cure to 10%- 50%. This will only be accurately known after the operation when the pathologist examines the removed pancreas. Your surgeon will receive the full pathology report 2-3 weeks after surgery.

What alternative treatments are available?

Chemotherapy may be able to shrink cancer or delay its growth. If the tumour has not spread, but cannot be removed surgically because it is extending to nearby structures, then you may be advised a combination of chemotherapy and radiotherapy. However, no treatment other than surgery is able to cure this problem.

After your Procedure

After the Procedure

  • After your operation your anaesthetist continues to monitor your condition carefully.
  • You will probably be transferred to a recovery ward where specially trained nurses, under the direction of anaesthetists, will look after you.
  • Your anaesthetist and the recovery nurses will ensure that all the anaesthetic effects are reversed and that you are closely monitored as you return to full consciousness.
  • You may be given some oxygen to breathe in the recovery area, and may find that intravenous drips have been inserted whilst you are unconscious in theatre and that these will be replacing fluids that you might require.
  • You will be given medication for any pain that you might feel, and systems, such as Patient Controlled Anaesthesia (PCA) may be set up to continue pain control on the ward.
  • You are likely to feel drowsy and sleepy at this stage. Some patients feel sick, others may have a sore throat related to the insertion of the breathing tube during surgery.
  • During this time it is important that you relax as much as you can, breathe deeply, do not be afraid to cough, and do not hesitate to ask the nursing staff for any pain relief, and about any queries you may have.
  • You are likely to have hazy memories of this time and some patients experience vivid dreams.
  • The length of your hospital stay will depend on a number of factors including how complex your procedure was and how your body recover’s from the operation.
  • Your doctor and their team will discuss your specific recovery and what you should do once you leave hospital.

Learn more about the procedures on offer

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Dr Charbel Sandroussi

Specialist in GI and General Surgery


Fax: Hours

Mon – Fri: 9:00 – 17:00