Distal pancreatic resection

Published on 09/04/2015 by admin

Filed under Surgery

Last modified 09/04/2015

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CHAPTER 11 Distal pancreatic resection

Step 2. Preoperative consideration

Patient preparation

A contrast-enhanced computed tomography (CT) scan utilizing a pancreatic protocol is obtained for preoperative assessment of pancreatic disease. This study provides images of the pancreas during arterial and venous phases to allow for a full evaluation of smaller lesions and to help delineate the relationship of the splenic vessels to the lesion.

Patients with radiographic abnormalities of the body and tail of the pancreas usually undergo endoscopic ultrasound with or without FNA (fine needle aspiration) and cystic fluid sampling if indicated.

In patients with a dilated pancreatic duct, an Endoscopic Retrograde Cholangiopancreatography (ERCP) may be useful for evaluating the papilla and ductal anatomy and its relationship to the lesion. Alternatively, Magnetic Resonance Cholangiopancreatography (MRCP) is also useful as a noninvasive means for elucidating pancreatic pathology and anatomy.

In our institution, a pancreas protocol CT and EUS (Endoscopic Ultrasound) fully assess the majority of patients and obviate the need for additional studies.

If splenectomy is anticipated, then preoperative vaccination against encapsulated bacteria (H. Influenza, Streptococcus, Meningococcus) should be given 7 to 10 days before surgery.

Patients with functional pancreatic neuroendocrine tumors may require preoperative hospitalization to optimize physiologic status.

Similar to other major abdominal surgeries, preoperative antibiotics and DVT (deep venous thrombosis) prophylaxis are provided per Surgical Care Improvement Project (SCIP) guidelines.

Step 3. Operative steps