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Minimally invasive surgery for Acute Pancreatitis

Minimally Invasive Surgery for Acute Pancreatitis

Minimally invasive surgery for Acute Pancreatitis in Mukundapur

Acute pancreatitis is a gastrointestinal condition that involves inflammation of the pancreas. The severity can range from mild to severe, depending on the individual factors of the patients, and can lead to organ failure, and sometimes fatality if not treated promptly within 48 hours. Acute pancreatitis is generally classified into two categories: interstitial edematous pancreatitis (IEP), i.e., swelling or inflammation of the pancreas or surrounding tissues without any tissue damage; and necrotizing pancreatitis (NP), where the death of the pancreatic tissues and the surrounding tissues is present (necrosis).

While Cholecystectomy and Necrosectomy are traditional surgical approaches for acute pancreatitis caused by gallstones or tissue necrosis, respectively, many minimally invasive procedures have been introduced, such as ERCP (Endoscopic Retrograde Cholangiopancreatography), offering several benefits to patients, such as reduced hospitalisation, minimal scarring, fewer complications, quick recovery, and improved cosmetic appearance. At Manipal Hospitals, Mukundapur, Kolkata, specialists in the Department of Gastrointestinal Science are well-equipped and adept at handling challenging cases of acute pancreatitis by utilising state-of-the-art techniques, ensuring optimal surgical outcomes for our patients.

FAQ's

Gastrointestinal specialists employ several minimally invasive procedures to address acute pancreatitis, some of which include:

  • Laparoscopic Cholecystectomy, which involves the use of a slender tool that is fixed with a camera and light at the end, called the Laparoscope, to remove the gallbladder.

  • Endoscopic Retrograde Cholangiopancreatography (ERCP) for diagnosing and treating biliary tract stones or pancreatic duct obstruction. 

  • Percutaneous Catheter Drainage in necrotizing acute pancreatitis.

  • Endoscopic Necrosectomy for severe acute pancreatitis.

  • Laparoscopic Transgastric approach, which employs a laparoscope to make a pathway between the stomach and the pancreas to drain fluid or pus into the stomach.

Minimally Invasive Retroperitoneal Pancreatectomy (MIRP), which entails the involvement of an endoscope to surgically remove dead pancreatic tissue.

Possible causes that can lead to acute pancreatitis include:

  • Presence of gallstones
  • Heavy alcohol consumption and smoking
  • High levels of cholesterol or hypertriglyceridemia
  • Drug-induced or Idiopathic pancreatitis
  • Iatrogenic trauma-induced pancreatitis, such as ERCP or Abdominal Surgery
  • Narrowing of the ampulla of Vater
  • Due to autoimmune diseases or infections
  • Congenital anomalies or genetic disorders
  • Hypercalcemia, or increased calcium levels in the blood, which can lead to calcium deposits in the pancreas
  • Renal diseases, toxins, or vasculitis

Diagnosis of acute pancreatitis usually involves the identification of symptoms such as unexplained weight loss, the onset of diabetes, and other factors such as history of alcohol, smoking, medications, or surgery, and family history of autoimmune disease or acute pancreatitis. Based on the initial evaluation, specialists may recommend either one or multiple screening procedures or imaging tests mentioned below:

  • Laboratory evaluation, including finding out levels of serum triglyceride, calcium, liver biochemical tests, lipase or amylase level, and genetic history

  • Chest radiography

  • Computed tomography (CT) with contrast

  • Endoscopic ultrasound (EUS)

  • Magnetic resonance cholangiopancreatography (MRCP)

  • Diagnostic ERCP, which can be reserved for patients if EUS or MRCP gives abnormal findings

Some complications that might occur during or after undergoing a minimally invasive procedure for acute pancreatitis include:

  • Infection around the surgical site
  • Severe bleeding or haemorrhage around the surgical site
  • Intestinal or pancreatic fistula
  • Conversion to open procedures, such as Laparotomy
  • Patient death
  • Site leakage, or catheter misplacement in procedures related to  Percutaneous Catheter Drainage 

The necessity for surgery is usually based on the severity and type of disease you have. Mild acute pancreatitis usually subsides after a few days with adequate rest and treatment. Initial treatment for acute pancreatitis usually includes:

  • Intravenous (IV) fluids or Fluid Resuscitation to treat dehydration

  • Pain medications and antibiotics by oral or through IV

  • Nutritional support, which may encompass total parenteral nutrition (TPN) or low-fat formulations

Administration of synthetic medications such as Octreotide, although in exceptional cases

In case a minimally invasive procedure is advised for your condition, general instructions you can follow to prepare yourself include the following:

  • Inform our specialist of any current medications and comorbidities you have. Moreover, you should also let them know if you are or might be pregnant. You may be told to avoid certain medications, such as blood thinners or non-steroidal anti-inflammatory drugs (NSAIDs).

  • Abstain from eating or drinking for a certain period or unless specified before the procedure.

  • Leave all jewellery or accessories behind during the day of the procedure

  • Discuss with your specialist if anaesthesia is administered. You will have to arrange your transportation after the procedure.

If hospitalisation is required, talk to our specialist about the expected duration of your stay. Pack comfortable clothing and personal items accordingly.

The expected recovery time for patients who have undergone a minimally invasive procedure for acute pancreatitis may range from a few days to weeks, nevertheless, this can differ depending on the complexity of the condition, individual factors, and the pace of recovery. Our specialists will let you know your expected recovery duration based on your case.

Although factors like genetic or family history are inevitable, you can help in managing and taking appropriate steps to prevent pancreatitis, some of which include:

  • Abstaining from smoking or consuming alcohol, which can lead to severe complications

  • Maintaining a healthy lifestyle weight, results in reduced risk of getting gallstones, obesity, and diabetes

  • Adhering to medications tailored by our specialists to enhance your recovery

  • Attending regular follow-up appointments to monitor your progress

  • Seeking medical attention in case of any symptoms after the procedure

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