The Pancreas

The pancreas is a small organ, only six inches in length, located near the liver and intestines. The gland produces insulin and other hormones helping digest food and regulate the body’s glucose levels.

Reasons for pancreatic surgery

  • Cancer/Tumors
  • Chronic Pancreatitis
  • Cysts
  • Pancreatic Pseudocysts

Surgery is the only known cure for pancreatic cancer but remains viable only if the cancer is localized. Because the pancreas is deep within the body, tumors and many symptoms of cancer often go unnoticed in its early stages. If cancer spreads to other organs, blood vessels, or the body’s lymph nodes, surgery may not be enough to remove all of it.

Signs and symptoms of pancreas problems

  • Upper abdominal pain
  • Abdominal pain when lying flat on the back
  • Abdominal pain after eating or drinking
  • Unexplained weight loss
  • Anemia
  • Jaundice, yellowing of the skin and the whites of the eyes
  • Pale stools that do not flush easily

Pancreatic cancer can often spread to nearby organs and tissues, including the liver.

The Liver

The liver is the largest internal organ in the body, located below the right lung. Its primary functions are filtering the blood, clotting the blood, and aiding the absorption of nutrients. Cancer can form in the liver, but many times, cancer in the liver is secondary (metastatic). This means the cancer cells that are found are not liver cells. They are from the part of the body where the cancer began, like the colon, breast or esophagus.

Reasons for liver surgery

  • Liver Cancer
  • Cirrhosis
  • Hepatitis
  • Jaundice

A variety of factors can cause a condition of the liver. Excessive alcohol consumption and viral hepatitis can lead to liver inflammation, cirrhosis, and jaundice. However, even people who do not drink in excess can develop non-alcoholic liver disease.

Signs and symptoms of liver problems

  • Jaundice, yellowing of the skin and the whites of the eyes
  • A swollen, bloated abdomen
  • Abdominal tenderness
  • Dark-colored urine
  • Pain in the right shoulder
  • Nausea
  • Fluid retention
  • Irritated skin

In treating your pancreatic or liver disease, Surgical Associates will work with you to develop a personalized treatment plan based on the stage of your condition and your overall health.

The better prepared you are for your pancreatic or liver surgery, the more successful your recovery is likely to be. While planning ahead for your surgery, be sure to:

  • Complete a physical exam and additional tests as requested by your doctor.
    • These help ensure you are healthy enough for surgery and provide the doctor with detailed images of your organs.
  • Discuss your alcohol consumption with your doctor and stop drinking alcohol when your surgery is scheduled.
  • Complete blood tests and breathing tests as directed.
  • Stop smoking.
    • Smoking will slow your healing.
  • Stop eating and drinking before your surgery as directed.
  • Provide a complete list of current medications.
    • This includes over-the-counter medications, supplements, and herbal remedies.
  • Discuss the use of blood thinners with your doctor.
  • Discuss with your doctor how long you will need to take off work.
  • Arrange for someone to drive you home from the hospital following surgery.

Your surgeon at Surgical Associates will inform you of all the goals, risks, and benefits of your treatment prior to your surgery.

When pancreatic cancer is treated through surgery, part or all of the pancreas is surgically removed through a process called resection, which involves the removal of the cancer and surrounding tissues. The tumor needs to be small enough with no major blood vessels involved, and the cancer needs to be localized to the pancreas.

The most common type of pancreatic surgery is called a Whipple procedure. This involves removing the head of the pancreas and the lower part of the stomach, part of the small intestine, common bile duct, gallbladder, and surrounding lymph nodes. The remaining stomach and bile duct are then attached to the small intestine, and the pancreas is attached to the stomach or intestines. This procedure allows for pancreatic enzymes, bile, and stomach contents to mix together and flow into the small intestine, which is important for normal digestion.

If the cancer is too advanced to be removed completely, certain surgeries can be performed that can help with the symptoms of pancreatic cancer. Possible complications include infections in the abdomen, bleeding in the abdomen, leakage of digestive juices into the abdomen, and inflammation of the bile ducts.

The surgical approach for liver cancer depends on the size of the tumor and how advanced it is. During a partial hepatectomy, part of the liver is removed through resection. This is only an option for patients who are healthy enough for surgery and have enough healthy liver left to function. The tumor must be small enough, with no major blood vessels involved, and the cancer must be localized to the liver. The organ cannot be completely removed, because the body must retain at least a portion of the liver to function.

Most complications after liver surgery are small. However, some of the more serious complications include bile leaks, bleeding, liver failure, respiratory problems, blood clotting in the legs, pneumonia, and infection.

Additional treatments such as radiation or chemotherapy may be necessary in the treatment of pancreatic or liver cancer and will be further discussed with your oncologist.

Your next step following pancreatic or liver surgery is the recovery room, where staff will administer pain medication as needed. Nurses will help you walk the halls several times a day, and nutrition will be supplied intravenously until you are able to eat solids again. Surgical drains may be placed in the abdomen during surgery but will likely be taken out before release from the hospital. The length of your hospital stay will depend on the type of surgery you had, but most patients require a stay of one to two weeks.

Steps for healing at home:

  • Take all medications as directed.
  • Care for your incisions as directed.
  • Complete breathing and leg exercises.
  • Take off work for as long as your doctor suggests.
  • Return to Surgical Associates for follow-up appointments to monitor recovery.

If you experience excessive pain, a fever of 101 or higher, jaundice, lots of swelling or redness near your incision, or excessive drainage from your incision, call Surgical Associates immediately.

Will my insurance cover my surgery?

  • Call your insurance company and let them know that you are having surgery, what kind of surgery and the date of your surgery. They will give you a summary of your benefits.
  • If your surgery is elective, preauthorization may need to be obtained and Surgical Associates will submit the required information for preauthorization. Surgery will not be scheduled until we know that we have that preauthorization. Whether or not surgery is elective or not, Surgical Associates will contact your insurance to make sure precertification has been obtained.

What will be my arrival time for surgery?
The timing of your procedure is not figured out until the day before so you will receive instructions from your surgeon’s off What kind of prep will I need before my procedure?

This depends on the type of procedure you are having. Some procedures will require a bowel prep, other procedures require just nothing to eat or drink after midnight, and other procedures require just showering with an antibacterial soap the night before and the morning of surgery. Your surgeon’s office will give you these instructions when your surgery is scheduled.

Will I need to stay in the hospital overnight or go home the same day?
This depends on the type of surgery you have. Your surgeon will advise you on what to expect in this regard.

What about my medications? Will I need to stop any of them before surgery?
Bring your medications to your appointment with you so we can confirm what medications you are taking and advise you on how to take each medication before and after surgery. Blood thinners, for example, may have to be stopped for a period of time prior to surgery.

Will I need a driver?
Yes. Most procedures we do require an anesthetic of some type. However, if you do not have anesthetic, it would not be a bad idea to have someone come with you anyway. Some people get tense during their procedure and become shaky afterwards, even after a minor procedure. We would rather you get home safely instead of taking any chances.

How long will I be off of work?
The amount of time off of work depends on the type of surgery that you have. Your surgeon and appropriate office staff will guide you on the expected time off.

Will I have any restrictions after surgery?

  1. Depends on the type of surgery you have. You may have lifting restrictions for a short period of time, or eating restrictions, or shower/bathing restrictions.
  2. You will not be allowed to drive if you are taking any narcotics or medications that would inhibit driving safely.

Will I see my surgeon after surgery?
Yes. You will have a postop appointment 1, 2 or 3 weeks after surgery so we can check your incisions and make sure you are healing well and as expected.

What I have forms that need to be completed for my employer or disability company?
Surgical Associates has specific staff who will take care of filling out those forms. Bring the forms with you to your appointment. Make sure you have filled out your portion of the forms and signed wherever you are required to before handing them in. Also, make sure your name and date of birth on those forms and instructions on where to send the forms when they are completed by the office staff.

When can I drive after surgery?
After surgery you will be sore and have some limited mobility. Once you are completely off of any narcotic pain medications and once you feel that you can quickly slam on the brake if you needed to, you can drive. Your surgeon will advise you on what to expect for the timing of this.