Surgical intervention in acute pancreatitis is either urgent or urgent, the procedure is performed in the first hours of the attack, as well as in the first days of the patient's manifestation of the disease. The indication in this case is peritonitis of the enzymatic or acute type, which is caused by blockage of the papilla of the duodenum. A delayed type of surgical intervention is carried out during the phase of rejection and melting of necrotic areas and retroperitoneal fiber. As a rule, this occurs on the tenth day after the onset of an acute attack in a patient.
Scheduled operations for pancreatitis are performed during the complete elimination of inflammatory processes in the diseased organ. The goal in this case is to prevent the recurrent course of the disease. Any measures are taken only after a thorough diagnosis, and in addition, a comprehensive examination of the patient. We will find out in which situations surgical intervention is required, and also find out what complications and consequences may arise during the recovery period.
When is pancreatitis surgery performed?
The need for surgical treatment is caused by ailments of the pancreas when observing severe lesions of organ tissues. As a rule, an operation is carried out in cases where alternative options lead only to failure, or when the patient is in an extremely serious and dangerous condition.
It should be borne in mind that any intervention in the organ of the human body is fraught with all sorts of negative consequences. The mechanical path never gives guarantees of patient recovery, but, on the contrary, there is always a risk of an extensive aggravation of the overall health picture. Symptoms and treatment of pancreatitis in adults are often interrelated.
In addition, only a highly qualified doctor of narrow specialization can carry out the operation, and not all medical institutions can boast of such specialists. So, pancreatic surgery in the presence of pancreatitis is carried out in the following situations:
- The patient's condition, marked by an acute phase of a destructive disease. With a similar picture, decomposition of the tissues of a diseased organ of a necrotic type is observed, while purulent processes can be added, which is a direct threat to the patient's life.
- The presence of pancreatitis in acute or chronic form, which went on to the stage of pancreatic necrosis, that is, necrotic stratification of living tissues.
- The chronic nature of pancreatitis, which is noted by frequent and acute attacks with a short time of remission.
All of these pathologies in the absence of surgical treatment can lead to fatal consequences. Moreover, any methods of conservative treatment will not give the necessary result, which is a direct indication for the operation.
The main difficulties in performing surgical treatment
Surgery on the background of pancreatitis is always a complex, as well as a difficult to predict procedure, which is based on a number of aspects that are associated with the anatomy of the internal organs of mixed secretion.
The tissues of the internal organs are highly fragile, so severe bleeding can be caused by the slightest manipulation. A similar complication during recovery of the patient is not excluded.
In addition, in the immediate vicinity of the gland are vital organs, and their slight damage can lead to serious malfunctions in the human body, as well as to irreversible consequences. The secret, along with the enzymes produced directly in the organ, affects it from the inside, which leads to tissue separation, significantly complicating the course of the operation.
Symptoms and treatment of pancreatitis in adults
Acute pancreatitis is characterized by the following symptoms:
- Severe abdominal pain with localization in both the right and left hypochondrium.
- General malaise.
- Elevated body temperature.
- Nausea and vomiting, but after emptying the stomach, relief does not occur.
- Constipation or diarrhea.
- Moderate dyspnea.
- Hiccups.
- Bloating and other discomfort in the stomach.
- A change in skin color - the appearance of bluish spots, yellowing or redness of the face.
The patient is placed in a ward where intensive care is conducted. In severe cases, surgery is required.
Prescribe drug therapy:
- antibiotics;
- anti-inflammatory drugs;
- enzymes;
- hormones;
- calcium
- choleretic drugs;
- herbal based coatings.
Complications after surgery
After operations with pancreatitis, the following complications are likely to occur:
- In the area of the abdominal cavity, necrotic or purulent contents may begin to accumulate, expressed in scientific language, the patient is diagnosed with peritonitis.
- It happens that there is an exacerbation of concomitant diseases associated with the activity of the pancreas and the production of enzymes.
- There is a process of clogging of the main channels, which can lead to an exacerbation of pancreatitis.
- The soft tissues of the diseased organ may not heal, and the positive dynamics of pancreatic recovery cannot be observed.
- The most dangerous complications include multiple organ failure along with pancreatic and septic shock.
- The later negative consequences of surgery for pancreatitis include the appearance of pseudocysts along with pancreatic fistulas, the development of diabetes mellitus and exocrine insufficiency.
Preparation for operation
Regardless of the type of pancreatitis, be it parenchymal, biliary, alcoholic, calculous, and so on, the main event in the preparation is absolute starvation, which, unfortunately, serves as an aid to exacerbate the ailment. What operations are done with pancreatitis, we will consider further.
The lack of food in the digestive system significantly reduces the likelihood of postoperative complications. Immediately on the day of the operation, the patient cannot be eaten, he is given a cleansing enema, after which premedication is performed. The latter procedure involves the administration of drugs that help the patient facilitate entry into an anesthesia. Such drugs completely suppress the fear of medical manipulation, helping to reduce the secretion of the gland and preventing the development of allergic reactions. For this purpose, various medications are used, ranging from tranquilizers and antihistamines to cholinolytics and antipsychotics.
The following are the techniques for surgery for acute pancreatitis.
Types of surgical interventions for pancreatitis
The following types of operations for pancreatitis are:
- Distal organ resection procedure. During the treatment process, the surgeon removes the tail, as well as the body of the pancreas. Excision volumes are determined by the degree of damage. Such a manipulation is considered appropriate in cases where the lesion does not affect the entire organ. The diet for pancreatitis after surgery is extremely important.
- Subtotal resection refers to the removal of the tail, most of the head of the pancreas and its body. At the same time, only some segments adjacent to the duodenum are preserved. This procedure is performed exclusively with the total type of lesion.
- Necrosecvestrectomy is performed as part of the control of ultrasound, as well as fluoroscopy. In this case, fluid is detected in the organ, conducting drainage through special tubes. After that, large-caliber drains are introduced in order to wash the cavity and carry out vacuum extraction. As part of the final stage of treatment, large drains are replaced with smaller ones, which contributes to the gradual healing of the postoperative wound while maintaining the outflow of fluid. Indications for pancreatitis surgery should be strictly observed.
Among the most common complications, purulent abscesses are found. They can be recognized by the following symptoms:
- The presence of febrile conditions.
- Hyperglycemia with a shift of the leukocyte formula to the left.
- The fullness of the affected area with pus during an ultrasound scan.
Rehabilitation and care of patients in a hospital
After surgery for pancreatitis, the patient goes to the intensive care unit. At first, he is kept in intensive care, where he is given proper care, and vital indicators are also monitored.
The patient's well-being in the first twenty-four hours greatly complicates the establishment of postoperative complications. Mandatory monitoring of urine, blood pressure, as well as hematocrit and glucose in the body. The necessary methods of control include chest x-ray and an electrocardiogram of the heart.
On the second day, subject to a relatively satisfactory condition, the patient is transferred to the surgical department, in which he is provided with the required care along with proper nutrition and complex therapy. Food after pancreatitis surgery is carefully selected. The scheme of subsequent treatment depends on the severity, and in addition, on the presence or absence of negative consequences of the operation.
Surgeons note that the patient must be under the supervision of medical personnel for one and a half to two months after surgery. This time is usually enough to allow the digestive system to adapt to modifications, as well as return to its normal work.
As recommendations for rehabilitation, patients after discharge are advised to strictly observe complete rest, as well as bed rest, in addition, such patients need an afternoon nap and diet. Equally important is the atmosphere in the home and family. Doctors note that relatives and relatives are required to support the patient. Such measures will enable the patient to be confident in the successful outcome of subsequent therapy.
Two weeks after discharge from the hospital ward, the patient is allowed to go outside, taking short walks with an unhurried step. It should be emphasized that in the process of recovery, patients are strictly prohibited from overwork. The consequences of pancreatitis surgery are presented below.
Postoperative therapy
As such, the treatment algorithm after surgery against pancreatitis is determined by certain factors. In order to prescribe therapy, the doctor carefully examines the patient’s medical history along with the final outcome of the intervention, the degree of gland restoration, the results of laboratory tests and instrumental diagnostics.
If there is insufficient pancreatic insulin production, insulin treatment may be additionally prescribed. Synthetic hormone helps to restore and normalize glucose in the human body.
It is recommended to take medications to help develop the optimal amount of enzymes, or already containing them. Such drugs improve the functioning of the digestive organs. In the event that these drugs are not included in the treatment regimen, the patient may develop symptoms such as increased gas formation along with bloating, diarrhea and heartburn.
What else involves surgical treatment of the pancreas?
Diet
In addition, patients are additionally recommended activities in the form of dietary therapy, therapeutic exercises and physiotherapy. A balanced type of diet is the dominant method in the recovery period. Compliance with the diet after resection of the organ involves a two-day fasting, and on the third day sparing food is allowed. In this case, it is permissible to eat the following products:
- Sugar-free tea with crackers and mashed soup.
- Porridge in milk with rice or buckwheat. During cooking, milk should be diluted with water.
- Steamed omelet, with only proteins.
- Dried bread yesterday.
- Up to fifteen grams of butter per day.
- Low-fat cottage cheese.
Before going to bed, patients are recommended to drink one glass of low-fat kefir, which can sometimes be replaced with a glass of warm water with the addition of honey. And only after ten days the patient is allowed to include some fish or meat products in his menu.
Medical prognosis of pancreatic surgery for pancreatitis
The fate of a person after surgery on the pancreas is determined by many factors, which include the condition before the operation, the methods of its implementation, along with the quality of therapeutic and dispensary measures, and in addition, the assistance of the patient himself and so on.
A disease or a pathological condition, whether it is an acute form of inflammation of the pancreas or cyst, as a result of which medical manipulations were used, as a rule, continue to affect the general well-being of a person, as well as the prognosis of the disease.
For example, if the resection is carried out due to cancer, then there is a high risk of relapse. The prognosis regarding the five-year survival of such patients is disappointing and amounts to up to ten percent.
Even insignificant non-compliance with the doctor’s recommendations, for example, physical or mental fatigue, as well as laxity in the diet can negatively affect the patient’s condition, provoking an exacerbation, which can lead to a fatal outcome.
Thus, the quality of life of the patient, as well as its duration after surgery on the pancreas, directly depends on the patient's discipline and compliance with all medical prescriptions.
Do you have surgery for pancreatitis? We found out yes.