Pancreatic Diseases

The pancreas is a vital organ behind the stomach that plays a key role in the digestive and endocrine systems. It produces digestive enzymes that help in breaking down food and hormones like insulin that regulate blood sugar levels.

Pancreatic diseases encompass a variety of disorders, with pancreatitis being the most common. Pancreatitis can be acute or chronic, often caused by factors like excessive alcohol consumption, gallstones, or certain medications. This inflammation of the pancreas can lead to severe abdominal pain, nausea, and complications if not managed properly.

Pancreatitis is the inflammation of the pancreas and is of two types: acute and chronic.

• Acute pancreatitis:
  It is sudden in onset and usually caused by gallstones or alcohol. Pancreatitis occurs when the digestive enzymes attack and destroy the pancreas. Acute pancreatitis that damages the pancreatic duct may progress to chronic pancreatitis.

• Chronic pancreatitis:
  The major cause is chronic alcoholism. It is characterised by abdominal pain, nausea, and vomiting.

Certain complications of pancreatitis may require surgery.

• If pancreatitis results from gallstones, cholecystectomy (surgical removal of the gallbladder) is performed.

Types of Cholecystectomy

• Robotic Cholecystectomy
  Newer technique which may allow faster recover, Prof. Apostolou will discuss with you if appropriate.

• Laparoscopic cholecystectomy:
  This operative technique removes the gallbladder using several small incisions instead of a large one. It employs a laparoscope, a thin tube with a tiny camera and lens, allowing the surgeon to view the inner area on a larger screen.

Other Surgical Interventions

If complications such as enlargement of the pancreas, bleeding, pseudocysts, or abscess development arise, surgical drainage, repair, or removal of the affected tissues may be necessary.

It is an uncontrolled cell division in the pancreas. Individuals with a habit of smoking, chronic alcoholism, and those having diabetes mellitus are at higher risk of developing cancer. The risk is also high in individuals with a family history of pancreatic cancer and hereditary pancreatitis.

Various diagnostic procedures are used to diagnose pancreatic cancer, such as:

• Abdominal ultrasound

• Abdominal computed tomography

• Percutaneous biopsy

• Endoscopic ultrasound with biopsy

Treatment depends on the stage of cancer and may include chemotherapy, radiation therapy, and/or surgery.

Decision making is part of a multidisciplinary team which A/Prof. Apostolou is a regular contributor and may chair at the Sydney Adventist Hospital.
Here a group of specialists including oncologists, surgeons and radiologists amongst others will discuss best practice options for treament of patients with this challenging problem.

Surgical Procedures

• Whipple procedure:
  This is the most common surgical procedure for cancer involving the head of the pancreas. In this procedure, the head of the pancreas, duodenum, gallbladder, and a portion of the stomach are removed. The gallbladder will also usually be removed at that time.

• Distal subtotal pancreatectomy:
  This surgical treatment is performed when the pancreatic cancer is in the body or tail of the pancreas. In this procedure, the body and tail of the pancreas, as well as the spleen, are removed. Appropriate immunisation is undertaken related to the splenectomy.

The pancreas produces insulin, a hormone that breaks up glucose.
Deficiency of this hormone causes diabetes mellitus.

Diabetes mellitus is of two types: type 1 and type 2.

• Type 1 diabetes: The pancreas loses its ability to make insulin because the body’s immune system attacks and destroys the cells in the pancreas that produce insulin.

• Type 2 diabetes: Due to insulin resistance, the insulin produced may not be sufficient to meet the body’s needs, thereby increasing glucose levels in the blood.

• Type 3c diabetes: As a result of damage or surgery to the pancreas. Assoc. Prof. Apostolou would enlist services of an Endocrinologist (Specialist in Diabetes) to assist with care of these patients.

Diabetes may also be a presenting feature of chronic pancreatitis and/or pancreatic cancer.

Robotic surgery utilises advanced technology to enhance the precision, control, and visualisation available to surgeons during a variety of procedures. This approach allows for greater dexterity and accuracy, which can be especially beneficial in complex or delicate operations.

Robotic surgery uses similar incisions to laparoscopic surgery but offers greater instrument dexterity and enhanced 3D high-magnification visualisation, which we hope leads to better outcomes for our patients.

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