Pancreatic Surgery

Question 1

Describe the four groups of patients presenting for

pancreatic surgery.

Answer 1

1. Patients with adenocarcinoma of the pancreas 2. Patients
   with complications resulting from chronic pancreatitis 3. Patients
   with acute pancreatitis, who have not responded to medical
   treatment 4. Patients with neuroendocrine islet cell tumors, such
   as insulinomas and gastrinomas
   Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
   Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
   Wolters Kluwer Health, 2014: 634.

Question 2

What blood sugar abnormality is seen following a

total pancreatectomy?

Answer 2

Hyperglycemia. A brittle diabetes results that is very difficult to
manage.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 636.

Question 3

Why would a surgical patient with acute pancreatis

be severely volume depleted?

Answer 3

Because of plasma exudation and in severe cases, hemorrhage
due to the erosion of blood vessels
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 634.

Question 4

A patient with adenocarcinoma of the pancreas
presents for surgery. What coagulation concerns
might this present?

Answer 4

Adenocarcinoma is associated with hypercoagulability.
Measures to prevent DVT and pulmonary embolism in patients
with adenocarcinoma.
Stoelting RK, Hillier SC. Pharmacology and Physiology in
Anesthetic Practice. Philadelphia, PA: Lippincott Williams and
Wilkins; 2006: 508.

Question 5

What is a Whipple Resection?

Answer 5

A Whipple Resection is comprised of a
pancreaticoduodenectomy, followed by a gastrojejunostomy, a
hepaticojejunostomy, and a pancreaticojejunostomy.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 632.

Question 6

What are common preop diagnoses seen in patients

presenting for a Whipple procedure?

Answer 6

Chronic pancreatitis, pancreatic cancer, malignant
cystadenomas
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 633.

Question 7

List contraindications to a Whipple procedure.

Answer 7

A Whipple procedure is contraindicated in cases of peritoneal or
liver metastases, tumor infiltration into the root of the
mesentery, superior mesenteric vessel involvement, and
hepatic artery involvement.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 569.

Question 8

List structures retained during a standard

pancreaticoduodenectomy.

Answer 8

Structures retained during a standard
pancreaticoduodenectomy include the body and tail of the
pancreas, proximal stomach, jejunum distal to the ligament of
Treitz, and the proximal biliary tree.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 632.

Question 9

List structures resected during a standard

pancreaticoduodenectomy.

Answer 9

Structures resected during a standard
pancreaticoduodenectomy include the entire duodenum, distal
stomach, gallbladder, distal extrahepatic biliary tree, and the
head and neck of the pancreas.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 632.

Question 10

What is a distal pancreatectomy?

Answer 10

A distal pancreatectomy is the excision of the distal half of the
pancreas due to pancreatic cancer, cystic neoplasms, chronic
pancreatitis, pseudopapillary tumors, or islet cell tumors.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 629.

Question 11

What is the Child’s procedure? What patient

population is this primarily used to treat?

Answer 11

The Child’s procedure involves the removal of the entire
pancreas with the exception of a small amount of tissue running
along the lesser curvature of the duodenum. The Child’s
procedure is primarily used for patients suffering from chronic
pancreatitis.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 629.

Question 12

What postoperative complications can be seen

following a distal pancreatectomy?

Answer 12

Wound infection, diabetes, damage to the common bile duct,
diabetes, hemorrhage, pancreatic insufficiency, pancreatic
leakage, formation of a pancreatic fistula
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 631.