Reasons for Procedure Pancreatic Cancer Chronic Pancreatitis Severe trauma to the Pancreas
Diagnostic Procedures CT scan Needle biopsy Cholangiopancreatography Endoscopic ultrasound Palpation of the pancreas
Procedure Summary Resection Part or all of the pancreas, duodenum, gallbladder, distal stomach and surrounding lymph nodes are identified and removed. Reconstruction Attachment of left over stomach, left over pancreas, and common bile duct to the jejunum. ** Class II wound unless spillage occurs.
Supplies and Instrumentation Supplies Prep set Basic pack Basin set Blades ○ #10 ○ #11 Laparotomy drapes Bovie Suture ○ Doctors Pref. Dressing ○ Doctors Pref. Hemostatic agents Suction Head lamp Instrumentation Major instrument set Vascular instruments Biliary instruments (in room) Long instruments Bowl resection set Retractors ○ Hand held ○ Self Retaining Ligating clip appliers and clips Staplers Drains
Operative Prep Anesthesia General Positioning Supine with arms on arm boards Skin Prep Shave Begin where incision will be. Extends from chest to upper thighs and down to the table on both sides Draping Lap sheet outlined with towels Incision Left Sub-costal or upper midline **Special consideration -Lubricate and protect the patient’s eyes
Operative Procedure Resection Incision is made Exploration of the abdomen and assessment of the extent and resectability of the tumor is made. Cholecystectomy Removal of Lymph nodes in the surrounding area Partial Gastrectomy Vagotomy Division of the Pancreas Dissection of the retro-pancreatic vessels Removal of Duodenum
Operative Procedure Reconstruction Pancreaticojejunostomy Hepaticojejunostomy End-to-side gastrojejunostomy NG tube placed Drains placed behind the pacreatic and biliary anastomoses Stab wound made on the right side of the abdomen where drain tube exits. Secured at the skin level with 3-0 silk Counts take place 4 total Counts Abdomen closed
Post-Op Immediate Postoperative Care Transport to PACU Possible Complications Hemorrhage Wound Infection Fistula formation Recurrence of Pathology Leakage of Anastomosis Nutritional/Digestive concerns Ileus Prognosis Depends on response to primary condition Mortality rate is 5% when surgery is performed by an experienced surgeon.