Difference between revisions of "Pancreatectomy"
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{{Infobox surgical procedure | {{Infobox surgical procedure | ||
| anesthesia_type = | | anesthesia_type = General | ||
± Epidural | |||
| airway = ETT | | airway = ETT | ||
| lines_access = | | lines_access = PIV x2 | ||
Arterial line | |||
| monitors = Standard | | monitors = Standard | ||
| considerations_preoperative = Electrolyte disturbances | 5-lead ECG | ||
| considerations_intraoperative = Hypovolemia | Temperature | ||
ABP | |||
| considerations_preoperative = Electrolyte disturbances | |||
Diabetes management | |||
| considerations_intraoperative = Hypovolemia | |||
Glucose management | |||
| considerations_postoperative = | | considerations_postoperative = | ||
}} | }} | ||
A pancreatectomy can be indicated for conditions such as pancreatic stones, cysts, benign or malignant tumors, ductal obstructions, or chronic pancreatitis. It can be classified as '''total''', where the entire organ is removed, often along with the spleen, gallbladder, local lymph nodes, the common bile duct, and portions of the small intestine and stomach, or '''partial''', where the pancreas is resected from the mesenteric vessels distally, leaving the head and uncinate process intact. | A '''pancreatectomy''' can be indicated for conditions such as pancreatic stones, cysts, benign or malignant tumors, ductal obstructions, or chronic pancreatitis. It can be classified as '''total''', where the entire organ is removed, often along with the spleen, gallbladder, local lymph nodes, the common bile duct, and portions of the small intestine and stomach, or '''partial''', where the pancreas is resected from the mesenteric vessels distally, leaving the head and uncinate process intact. | ||
== Preoperative management == | == Preoperative management == | ||
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* CBC | * CBC | ||
* Electrolytes | * Electrolytes | ||
* | **Especially K+, serum glucose, BUN, Cr | ||
* Coagulation panel | |||
* LFTs | * LFTs | ||
* | * Urinalysis | ||
* EKG | * EKG | ||
* CXR | * CXR | ||
* | * TTE is commonly requested | ||
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | === Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | ||
* Have insulin available for glucose management | * Have insulin available for glucose management | ||
*Have pressor (usually norepinephrine) available for management of hypotension | |||
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | === Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | ||
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=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | === Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | ||
* | * Arterial line | ||
*2 large bore IVs | |||
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | === Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | ||
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | === Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | ||
* Supine | |||
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | === Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | ||
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=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> === | === Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> === | ||
* Floor vs. ICU | |||
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | === Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | ||
* Epidural is common for postoperative pain management | |||
* TAP blocks are an alternative for patients who cannot receive epidurals | |||
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | === Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | ||
* Endocrine and exocrine insufficiency | |||
* Wound infection | |||
* Duodenal necrosis | |||
* Diabetes | |||
* Hemorrhage | |||
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | == Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | ||
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|+ | |+ | ||
! | ! | ||
! | !Total | ||
! | !Near-Total (Child's Procedure) | ||
!Partial (Distal) | |||
|- | |- | ||
| | |Indications | ||
| | |Pancreatic stones, cysts, ductal obstruction, benign or malignant tumor, chronic pancreatitis | ||
| | |When underlying disease has functionally destroyed the pancreas or when lesser procedures have failed to provide adequate pain relief | ||
|Tumor or pancreatitis | |||
|- | |- | ||
| | |Surgical procedure | ||
| | |Entire organ removed, usually with spleen, gallbladder, local lymph nodes, CBD, portions of SI and stomach. Remaining distal stomach is anastomosed to a portion of the SI | ||
| | |Removal of entire pancreas except rim of tissue along the lesser curvature of the duodenum, which makes it unnecessary to reconstruct the bile duct | ||
|Resection of the pancreas from the mesenteric vessels distally, leaving the head and uncinate process intact | |||
|- | |- | ||
|Surgical time | |Surgical time | ||
| | |3-6h | ||
|3-6h | |||
| | | | ||
|- | |- | ||
|EBL | |EBL | ||
| | |300-500cc | ||
|300-500cc | |||
| | | | ||
|- | |- | ||
|Postoperative disposition | |Postoperative disposition | ||
| | |||
| | | | ||
| | | | ||
|- | |- | ||
|Pain management | |Pain management | ||
| | |||
| | | | ||
| | | | ||
|- | |- | ||
|Potential complications | |Potential complications | ||
| | |||
| | | | ||
| | | | ||
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[[Category:Surgical procedures]] | [[Category:Surgical procedures]] | ||
[[Category:General surgery]] | |||
[[Category:Pancreatic surgery]] | |||
Latest revision as of 12:40, 5 April 2022
Pancreatectomy
| Anesthesia type |
General ± Epidural |
|---|---|
| Airway |
ETT |
| Lines and access |
PIV x2 Arterial line |
| Monitors |
Standard 5-lead ECG Temperature ABP |
| Primary anesthetic considerations | |
| Preoperative |
Electrolyte disturbances Diabetes management |
| Intraoperative |
Hypovolemia Glucose management |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
A pancreatectomy can be indicated for conditions such as pancreatic stones, cysts, benign or malignant tumors, ductal obstructions, or chronic pancreatitis. It can be classified as total, where the entire organ is removed, often along with the spleen, gallbladder, local lymph nodes, the common bile duct, and portions of the small intestine and stomach, or partial, where the pancreas is resected from the mesenteric vessels distally, leaving the head and uncinate process intact.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | |
| Neurologic | |
| Cardiovascular | |
| Pulmonary | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | Diabetes is common in these patients, glucose management should be considered |
| Other | Electrolyte derangements and hypovolemia common in patients with pancreatitis |
Labs and studies
- CBC
- Electrolytes
- Especially K+, serum glucose, BUN, Cr
- Coagulation panel
- LFTs
- Urinalysis
- EKG
- CXR
- TTE is commonly requested
Operating room setup
- Have insulin available for glucose management
- Have pressor (usually norepinephrine) available for management of hypotension
Patient preparation and premedication
Regional and neuraxial techniques
- Epidurals are common to manage postoperative pain
- If epidural is not performed, TAP blocks can be an alternative
Intraoperative management
Monitoring and access
- Arterial line
- 2 large bore IVs
Induction and airway management
Positioning
- Supine
Maintenance and surgical considerations
Emergence
Postoperative management
Disposition
- Floor vs. ICU
Pain management
- Epidural is common for postoperative pain management
- TAP blocks are an alternative for patients who cannot receive epidurals
Potential complications
- Endocrine and exocrine insufficiency
- Wound infection
- Duodenal necrosis
- Diabetes
- Hemorrhage
Procedure variants
| Total | Near-Total (Child's Procedure) | Partial (Distal) | |
|---|---|---|---|
| Indications | Pancreatic stones, cysts, ductal obstruction, benign or malignant tumor, chronic pancreatitis | When underlying disease has functionally destroyed the pancreas or when lesser procedures have failed to provide adequate pain relief | Tumor or pancreatitis |
| Surgical procedure | Entire organ removed, usually with spleen, gallbladder, local lymph nodes, CBD, portions of SI and stomach. Remaining distal stomach is anastomosed to a portion of the SI | Removal of entire pancreas except rim of tissue along the lesser curvature of the duodenum, which makes it unnecessary to reconstruct the bile duct | Resection of the pancreas from the mesenteric vessels distally, leaving the head and uncinate process intact |
| Surgical time | 3-6h | 3-6h | |
| EBL | 300-500cc | 300-500cc | |
| Postoperative disposition | |||
| Pain management | |||
| Potential complications |
References
Top contributors: Olivia Sutton and Chris Rishel