The pancreas produces enzymes that serve in digestion and hormones that regulate blood sugar. We treat both benign and cancerous conditions of the pancreas with the following surgical procedures:
Commonly called the Whipple procedure, we perform pancreaticoduodenectomy to treat cancers of the pancreas, premalignant lesions like cysts, and benign masses. It involves removing the head of the pancreas, the duodenum, a portion of the bile duct, and the gallbladder. Learn more.
Left or Distal Pancreatectomy
In a distal pancreatectomy, we remove the body and/or tail of the pancreas using robotic, laparoscopic, or open surgical techniques. In some cases, we also remove the spleen. Learn more.
Distal Pancreatectomy with Celiac Axis Resection (Appleby Procedure)
The celiac artery supplies blood to the liver, pancreas, spleen, and stomach. If you have advanced adenocarcinoma of the pancreas that involves this artery, an Appleby procedure can be considered. This removes the left pancreas, spleen, and the celiac artery while preserving blood flow to the liver and stomach. It can also involve reconstruction or replacement of the artery with a graft if the blood flow to the liver is not adequate.
Retrograde Anteromodular Pancreaticosplenectomy (RAMPS)
RAMPS is a specialized procedure that entails removal of the left pancreas and its surrounding structures ensuring adequate margins and lymph node harvest. This has been shown to result in improved survival outcomes for patients with large tumors on the left side of the pancreas.
In a central pancreatectomy, the middle of the pancreas is removed. This preserves function in the pancreas by leaving you with a working pancreatic head and tail but requires reconstruction of the flow of pancreatic juice using the intestine. A subset of patients with lesions in the middle of the pancreas may be candidates for this procedure.
Enucleation of Pancreatic Masses
With this procedure, we avoid cutting out a large portion of the normal pancreas by just removing the tumor itself. This helps to preserve normal pancreas function and limit the risk of diabetes or decreased digestive function after surgery. This approach is used primarily for neuroendocrine tumors, especially insulinomas. We can perform this surgery with either robotic, laparoscopic, or open techniques.
Pancreatic Drainage Procedures
Pancreatic drainage procedures (which include Frey, Peustow, Beger, and others) are surgical options that can include draining the pancreas duct and removing part of the pancreas. They are usually suggested when the pancreatic duct is blocked with stones and the patient has significant pain as a result. They can be effective for some patients with chronic pancreatitis.
A total pancreatectomy is the removal of the entire pancreas and usually the spleen to treat chronic pancreatitis when no other surgical options are available. In rare cases, it can also be used to treat cancers. We offer this procedure robotically, which speeds recovery. It will take time to get used to life without a pancreas, which will involve dietary changes and medication. Learn more.
Total Pancreatectomy with Auto Islet Cell Transplant
Complete removal of the pancreas will cause diabetes. In order to prevent the onset of diabetes or limit its severity, you may be a candidate for an auto islet cell transplant. During this advanced procedure, your own islet cells are removed and infused back into your liver, where they can implant and grow, producing insulin. MedStar Georgetown University Hospital is one of the only hospitals in the country that has a lab that can harvest islet cells. We are also one of the few programs that offer the operation robotically. Learn more.
Pancreatic Pseudocyst Drainage
After an episode of acute pancreatitis, some patients will need the fluid that has accumulated into the pancreatic cavity drained. We can accomplish this with surgery, either laparoscopically or robotically, or sometimes with an incision, that creates a connection between the cyst and the stomach (cyst-gastrostomy) or between the cyst and the small bowel (cyst-jejunostomy). This is offered when the treatment cannot be accomplished endoscopically.
We perform pancreatic necrosectomy to remove dead tissue as a result of acute pancreatitis. We select the easiest surgical option available that is least invasive, which could include endoscopic or percutaneous approaches. A combination surgical approach with the percutaneous route is called videoscopic assisted retroperitoneal debridement (VARDs). In VARDs, we create small incisions that are guided by prior percutaneously placed drains to access dead or infected tissue in the cavity.