Pancreatic Procedures

Distal Pancreatectomy and Splenectomy

A distal pancreatectomy is a surgery to remove a tumour from the body or tail of your pancreas. Your pancreas is located in the back of your abdomen behind your stomach and above your small intestine. Your pancreas makes enzymes that help digest the food you eat, including fats. It also makes insulin and glucagon, which are hormones that help regulate your blood sugar levels.

Your pancreas has 3 parts: the tail, the body, and the head.Even though part of your pancreas will be removed during your surgery, there’s usually enough of it left after your surgery to make hormones and enzymes.

The most common indication for distal pancreatectomy is pancreatic cancer in the body or tail of the pancreas. In those cases, the distal pancreatectomy is combined with splenectomy for oncological purposes in order to remove the vessels that run along the posterior aspect of the pancreas and all the regional lymph nodes.

Dr Papoulas is one of the most experienced pancreatic surgeons and a referral point for pancreatic surgery in Cyprus. The majority of distal pancreatectomies and splenectomies are performed laparoscopically through 4 tiny incisions. The duration of surgery is around 3 hours and the length of stay 3 days. Laparoscopic distal pancreatectomy and splenectomyoffers smaller incisions, shorter hospitalization, less pain, and a faster return to work and life when compared to the traditional (open) technique.

Spleen Preserving Distal Pancreatectomy

In a traditional “distal” pancreatectomy (removing the tail/left side of the gland), the spleen is removed with the pancreas because the major splenic blood vessels run through the tail of the pancreas itself. However, in cases of pancreatic surgery for benign disease (e.g., pancreatic cysts), resection of the spleen is not required as a portion of the operation itself, but is typically removed because of its anatomic proximity alone. Splenic-preservation is a technically demanding technique in which the blood supply to the spleen is carefully preserved so that it can be left behind, preserving the immunologic function of the spleen and reducing the risk of long-term infectious complications. Dr Papoulas has the expertise and the skills to perform this demanding procedure laparoscopically through tiny incisions.

Whipple’s procedure

A Whipple procedure — also known as a pancreaticoduodenectomy — is a complex operation to remove the head of the pancreas, part of your stomach, the first part of the small intestine (duodenum), the gallbladder and the bile duct.

The Whipple procedure is used to treat tumors and other disorders of the pancreas, intestine and bile duct. It is the most often used surgery to treat pancreatic cancer that is confined to the head of the pancreas. After performing the Whipple procedure, your surgeon reconnects the remaining organs to allow you to digest food normally after surgery.

The Whipple procedure is a difficult and demanding operation and can have serious risks. However, this surgery is often lifesaving, particularly for people with cancer. The majority of the pancreaticoduodenectomies are performed via open surgery and the average duration is 5.5-6 hours. Length of stay is around 6 days but this can be prolonged in case of postoperative complications. The most common complication is the leakage from the pancreaticojejunostomy which happens in about 15% of cases. This is mostly treated conservatively without the need for further interventions or surgical procedures.

Dr Papoulas is one of the most experienced and highly specialised pancreatic surgeons in Cyprus. He is the only pancreatic surgeon who is also trained in transplantation and hence has the ability to perform complex pancreatic resections with vascular reconstructions in case of pancreatic tumours affecting nearby blood vessels.

Total Pancreatectomy

During Total Pancreatectomy, your surgeon will remove the whole of your pancreas. Because of where your pancreas is located, there will also be a need to remove your duodenum (the first part of your small intestine), the end of your common bile duct, your gallbladder, and your spleen. Your surgeon will reconnect your stomach and remaining portion of your common bile duct to your jejunum (the second part of your small intestine). This ensures that food and bile flow into your small intestines. This surgery takes around 5 hours and the length of stay is about 5 days.

When your pancreas is removed, you will have diabetes. You’ll need to test your blood sugar level and take insulin to keep it at a safe level. You will meet with an endocrinologistin the hospital who will help you manage your diabetes. You will also need to take pancreatic enzymes capsules with every meal to facilitate the absorption of fat since you will loose your exocrine function of the pancreas as well.

Common indications for total pancreatectomy are multicentre pancreatic tumors, multiple IPMNs throughout the pancreas with high risk features for malignancy, positive margins following partial pancreatectomy or severe complications associated to previous pancreatic anastomosis. Dr Papoulas is one of the most experienced pancreatic surgeons and a referral point for pancreatic surgery in Cyprus. He was trained in one of the largest Liver and Pancreas Units in Europe and has moved to Cyprus in 2019.

Enucleation of Pancreatic Tumors

A subset of benign or low-grade pancreatic tumors can be safely enucleated (carefully scooped out of the pancreas with a razor thin margin between tumor and pancreas) rather than requiring more extensive surgical removal of a portion of the pancreas. This strategy is technically demanding, but preserves pancreatic tissue and function. This procedure is mainly indicated for isolated small (less than 2cm) benign pancreatic tumors that are at least 3mm away from the main pancreatic duct.

Dr Papoulas is a highly experienced pancreatic surgeon that can perform enucleation of pancreatic tumors laparoscopically, providing to the patient the benefits of shorter hospitalization, less pain, and a faster return to work.