A pancreatic transplantation or pancreas transplantation refers to the surgical procedure, which involves replacing a dysfunctional pancreas with a healthy one.  The donor of the pancreas is usually a deceased person. Pancreas is an important organ of the body as it produces several important hormones, which play a significant role of regulating our body cycles. Pancreas transplantation is usually performed for the treatment of type 1 diabetes which is linked to the inability of the pancreas to produce the insulin hormone.

A pancreatic transplant is considered as one of the potential cures for type 1 diabetes. However it is not considered to be a standard treatment due to complications, such as:

Rejection of graft by the recipient body or similar complications
The medications which are given to prevent the rejection can have serious side effects too
Certain complications like blood clots or infections can occur following the procedure
Failure to control the blood sugar levels and rejection of the graft or complete pancreatic failure are Common complications that occur after a pancreas transplant.
These are the primary reasons why pancreas transplant is often considered to be one of the last measures of treating diabetes. Nevertheless, there are certain conditions where a pancreas transplant is worth considering. Some of the conditions include diabetes which cannot be controlled with the usual treatment procedure, chronic poor blood sugar control, insulin reactions which turns chronic or a serious kidney disease.

Certain medications are also prescribed for anti rejection purposes. These medications need to be taken after the operation for the rest of your life to prevent rejection of the donor graft. These medications can have a few adverse side effects. Some of the side effects include hypertension, thinning of your bones, unwanted weight gain and a rise in your cholesterol levels. Swollen gums or acne are also observed in several cases.  

Often a pancreas transplant is carried out along with a kidney transplant, especially if you have a serious kidney condition. It helps to provide a healthy kidney and a pancreas and also reduces a risk of kidney damage caused due to diabetes later in the future.

Know More About Pancreatic Transplantation!

Pancreas are a small, but a pretty important part of a person s digestive system. So when it needs to be removed, the reason has got to be quite serious, to say the least, doesn t it? The procedure is known formally as a pancreatectomy and it is most often required for people who are suffering from cancer of the pancreas. Ideally, these people would only need the cancerous tumours removed, but things are not always this simple. As a matter of fact, only a little more than a tenth of the people who have pancreatic cancer can have the tumour alone removed. As a result, most need to go for a pancreatectomy, which involves removing the entire pancreas. Whether the pancreas can be kept is usually related to how soon the cancer was detected, with people who have done so in time being a majority of the 10% of people with pancreatic cancer who have not needed pancreatectomies.

If a person does not have cancer, the reason he or she may need a pancreatectomy due to an accident which has injured the area significantly badly. In this case, a procedure which is known as a partial pancreatectomy is carried out on the patient. The good news is that the success rate of this sort of operation is generally quite high and the long-term effects on the body are nil. This is the case in spite of a lot of the normal tissue of the pancreas being removed, pretty amazing, isn t it?

While it may be called a pancreatectomy, it does not always mean that the pancreas is the only thing that is removed. In fact, in a lot of pancreatectomies, the surgeons also remove other parts of the digestive system which are usually the common bile duct, the spleen and the gallbladder.

There is, of course, the case of chronic pancreatitis, which occurs when the organ just swells up repeatedly. The repeated swelling leads to permanent damage of it, which affects the rest of the body, too. In most cases, the cause of this happens to be a sustained addiction to alcohol. When this is the case, it is really hard to perform a pancreatectomy and the utility of the pancreas is greatly reduced. Not a good situation to be in, under any circumstances, at all!

A pancreatectomy is a process which nobody would voluntarily wish to undergo, but there are advantages to knowing what it is, in any case!

Pancreatectomy - When To Go For It?

Chronic pancreatitis refers to an inflammation of the pancreas   the organ that creates enzymes and hormones to manage blood sugar levels and aids in digestion. The condition either does not heal completely and keeps coming back, or persists for months or years at a stretch.

Chronic pancreatitis is a serious, debilitating condition, which can potentially lead to permanent damage and scarring of the organ. The following are the consequences-

  Formation of cysts and calcium stones in the pancreas
  Blockage of the gastrointestinal tract
  Malnutrition
  Diabetes

The condition is most likely to develop between the ages of 30 and 40 and is commonly observed in men than in women.

Causes of Chronic Pancreatitis:

A number of factors are responsible for long-term pancreatitis. The most common ones include-

  Alcohol abuse   Reportedly, 70% of all cases regarding the condition is related to alcohol consumption
  Autoimmune diseases   When your body attacks the healthy tissues and cells mistakenly
  Genetics
  A constrict pancreatic duct   The tube that carries enzymes to the small intestine from the pancreas
  A blockage of the pancreatic duct by stones
  Cystic fibrosis   A hereditary disorder that causes mucus to build up in the lungs
  Hypercalcemia   When the level of calcium in the bloodstream increases abnormally
  Hypertriglyceridemia   When the level of triglycerides in the blood rises up

Warning Signs of Chronic Pancreatitis:

Symptoms of chronic pancreatitis do not show up at the early stages. They become more evident when inflammation aggravates. However, you should look out for the following signs-

  Severe abdominal pain   Usually in the upper portion
  Loose stool that appears pale and does not flush away easily
  Vomiting and nausea
  Unintentional weight loss
  Fatigue
  Excessive thirst
  Shortness of breath
  Diarrhoea
  Jaundice
  Pancreatic fluids inside the stomach
  Intestinal blockage
  Internal bleeding

The above symptoms vary based on the severity of the condition. Painful episodes may last for days. For some people, drinking and eating seem difficult because that makes the pain worse. With the progression of persistent pancreatitis, the pain becomes constant. Seeking treatment at the earliest is necessary for the condition to heal.

Diagnosis and Treatment:

A blood test alone is not sufficient to detect the changes in your pancreas in the initial stages. An imaging test is the most reliable method to confirm the diagnosis. Your doctor may recommend the following tools-

  CT Scan
  X-ray
  Ultrasound
  MRI Scan

The objective of the treatment is to reduce pain and improve the functioning of your digestive system. The damage to the pancreas cannot be cured, but your doctor will prescribe necessary measures to manage the symptoms of the condition.

The primary treatment methods include endoscopic therapy, medications, and surgery.

  Medication - Pain killers, insulin steroids, and artificial digestive enzymes may be taken as per the doctor s recommendation
  Endoscopy - The procedure involves inserting a flexible, long tube (known as an endoscope) through the mouth. It allows the doctor to look at the pancreatic stones formed inside. He/she then removes the stones, places stents to improve the flow, and seals the leakage.
  Surgery - The last resort is surgery. The doctor will recommend it only if medications and endoscopy therapy have failed to rectify the painful symptoms. Removing a portion of the diseased pancreas can offer relief. Surgery may also be performed to drain cysts and to unblock or widen the pancreatic duct.

The outlook depends on the underlying causes and the seriousness of the disease. However, immediate treatment and diagnosis can improve the outlook. Consult a doctor as soon as you encounter the above symptoms of pancreatitis.

Chronic Pancreatitis - Everything You Should Be Knowing!

Problems are pancreas are common and are treated by gastroenterologists. There are two common pancreas problems -

1. Acute Pancreatitis: Sudden Inflammation of the pancreas is known as acute pancreatitis. It is usually due to Alcohol, gall stones, trauma, metabolic causes such as hypertriglyceridemia, and congenital causes such as Pancreas divisum. The patient presents with severe upper abdominal pain and vomiting. Patients require admission for IV fluids and analgesics. Nearly all patients recover from the pain and start eating within 3 to 4 days. Few patients with severe pancreatitis may develop kidney failure, respiratory failure or GI bleeding. Such patients require longer hospitalisation stay and critical care management. Recovery is usually uneventful but few patients develop peripancreatic fluid collection known as Pseudocyst or walled-off pancreatic necrosis(WOPN). In such cases, the patient requires additional treatment of fluid collection and requires internal drainage by Cystogastrostomy which is done by Endosonography (EUS) by a gastroenterologist. Some patients require ERCP (Endoscopic retrograde cholangiopancreatography) for evaluation of pancreatic ductal leak. EUS and ERCP are advanced endoscopic procedures done by a few gastroenterologists who are specially trained in such procedures.

2. Chronic pancreatitis: Long term irreversible damage to the pancreas is called chronic pancreatitis. It is usually due to Alcohol intake. It presents with upper abdominal pain, Diabetes mellitus and fat in stools (steatorrhea). The small duct in the pancreas called main pancreatic duct can have hard calcifications also known as stones, which obstruct the flow of pancreatic juice and cause severe abdominal pain. Treatment of chronic pancreatitis includes stopping alcohol intake to prevent further damage to the pancreas, medicines for pain, Pancreatic enzyme replacement therapy (PERT) and Endoscopy for those who do not respond to medical treatment. Endoscopy includes ERCP and plastic stenting to establish a flow of obstructed pancreatic duct and Endosonography (EUS) guided Celiac plexus block for decreasing pain. Patients who develop fluid collection such as Pseudocyst require internal drainage by Cystogastrostomy which is done by Endosonography (EUS)

In Brief About Types Of Pancreatic Disorders!

Pancreas is a small organ that is located in the lower part of the stomach. It lies just behind the abdomen. It functions by producing the insulin hormone which is responsible for regulating blood sugar level in the body and breaking down food into glucagon which is stored in the body. This glucagon is converted into glucose which is used by the body for energy and other purposes. Therefore, pancreatic transplant is done in patients with a malfunctioning pancreas.

Why is pancreatic transplant required?
Patients suffering from type I diabetes usually undergo a pancreatic transplant. Type I diabetes is characterized by the inability of the pancreas to produce insulin, thereby leading to low blood sugar level. This type of diabetes occurs due to the malfunction of pancreatic beta cells whose primary role is to produce insulin. These beta cells make up around 65 to 80 percent of the cells found in the pancreatic islets. They typically malfunction when the body's immune system begins to attack and destroy the pancreatic beta cells. Therefore, type I diabetes is an autoimmune disorder. Patients with type I diabetes require insulin injections that might cause severe reactions. People dependent on insulin are prone to the development of diabetic retinopathy and diabetic nephropathy.

People with type II diabetes generally do not need pancreatic transplant because this type of diabetes occurs due to low production of insulin or lack of insulin resistance. Here is a list of the probable reasons why pancreatic transplant is required:

People who have type I diabetes but are not cured by standard treatment
Severe reactions to insulin injections
Low blood sugar
Kidney damage
Hypoglycemia unawareness
A pancreatic transplant can be of three types. They are:

Pancreas transplant only- People with type I diabetes and normally functioning kidneys require only a pancreatic transplant.
Pancreas and kidney transplant- Type I diabetes, in rare cases, leads to end-stage renal disease (ESRD) or end-stage kidney disease where one or both the kidneys are damaged. In such cases, pancreas and kidney are transplanted simultaneously to disable the dependence on insulin injection. This type of surgery may also be required when the pancreas and the kidneys come from the same donor.
Pancreas-after-kidney transplant- In some cases of type I diabetes, your doctor will recommend kidney transplant first followed by pancreatic transplant. It must be remembered that pancreatic transplant should be done by taking into consideration the side-effects caused by the anti-rejection injections administered after the procedure is performed. It may cause bone thinning, high cholesterol and high blood pressure in a patient s body. As the anti-rejection injections work by suppressing the immune system, the body s defense mechanism against infections and other diseases becomes ineffective to a considerable extent.
A pancreatic transplant is a serious procedure that requires a lot of deliberations and consultations with your doctor and should only be opted for when the benefits outweigh the side effects from the anti-rejection medications.

Pancreatic Transplant - When Is It Required?

Pancreatic cancer is an aggressive form of cancer. The disease shows no early symptoms and often spreads to other organs long before it is properly diagnosed. Due to such poor prognosis, only around 6% of the pancreatic cancer patients are healthy and alive 5 years after the first diagnosis.

One of the most common surgeries to remove tumours from the pancreas is Pancreaticoduodenectomy, that is commonly called Whipples surgery. The primary aim of the procedure is to cure cancers or disorders that are identified in the pancreas, bile duct or the duodenum. Here, the tumour is removed to prevent it from spreading to other organs, thus improving the life expectancy of the patient. 

Whipple's Procedure

Before the surgery, an intravenous line will be injected to your arm, to provide you with the necessary medication. Medicines may be passed through this line to soothe your nerves. A spinal injection or an epidural catheter may be placed. This helps you to recover painlessly after the surgery.

The surgery can be carried out in different ways  

Open surgery

Here, the surgeon makes a small incision in your abdomen to access the pancreas and other organs. This is the most common method. This is a complicated operation where the tip of the pancreas, the gallbladder, the bile duct and the initial portion of the small intestine are removed. It is performed to treat cancers that are present on the head of the pancreas. 

Laparoscopic surgery

Here several small incisions are made in your abdomen to insert a camera that transmits the live video of the abdomen to a monitor. According to the live feed, the surgeon performs the operation by using surgical tools. It is a common form of minimally invasive surgery.

Robotic operation

This is another type of minimally invasive surgery where the surgical tools are attached to a special robot. Here, the doctor uses a console to control the robot to perform the surgery. This is used because surgical robots can reach and operate in spaces and corners where the human hands may not reach during surgery.

 The Whipples surgery can take 4 to 12 hours depending upon the approach being used and the complexity of the process. During the surgery, you will be given general anaesthesia, so you will be asleep.

In some cases, a part of your stomach or nearby lymph nodes may be removed to treat the cancer growths. After the process, the doctor will reconnect the other organs so that you can digest food normally.

After the procedure, you may face problems while emptying your bowels. The condition improves around 7 to 10 days after the surgery. Most patients are able to return back to their normal life usually around 6 weeks after the procedure.

It is recommended that you follow the doctor s instructions after the surgery and stick to the diet prescribed. Additionally, keep the incision protected from sunlight and remove the bandages only after consulting the doctors. 

 

 

Whipples Surgery & Pancreatic Cancer - Know About Them!

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