Surgeons at Johns Hopkins School of Medicine in Baltimore have developed a minimally invasive surgery to treat chronic pancreatitis. Currently the condition is treated with pancreatectomy, removal of the pancreas.
Chronic pancreatitis occurs when the pancreas becomes inflamed and the inflammation lasts for months or years. The common causes include gallstones, medicines, alcohol abuse, autoimmune disease and a narrow pancreatic duct.
“The people that come to us with a gene mutation that is no fault of their own have already been accused multiple times of being alcoholic and been told that there’s nothing to be done and that they’re drug seeking patients,” said Martin Makary, a professor of surgery at Johns Hopkins. “Many of these patients have had their lives ruined by this disease.”
Pancreatectomy can be extremely painful, risky and require long-term recovery up to eight weeks or longer. The minimally invasive surgery developed by the Hopkins team can result in fewer complications and opioids, as well as less pain, Makary said.
The new procedure has been dubbed laparoscopic total pancreatectomy with islet cell autotransplantation. During the procedure, the surgeons remove the pancreatic islets, also known as islets of Langerhans, and transfer them to the liver, so they can continue to produce insulin for blood glucose management. The islet cells can last anywhere from five to 10 years before they wear out.
To gain access to the pancreas, the surgeons remove the gallbladder and spleen. After the pancreas is removed, the organs are placed back into their original position. An incision is made in the naval or bellybutton and then a laparoscope is inserted into the opening to remove and replace the organs back into the abdominal cavity.
Over a three-year period, the surgeon performed the surgery 20 times. Six months after the surgery, nearly all of the 20 patients reported less or no pain. In fact, sixty percent of the patients reported no pain and no longer needed to be prescribed opioids.
Patients who undergo a pancreatectomy develop diabetes and require enzyme tablets for the rest of their life.
“While the operation is not a perfect solution because some patients do become diabetic eventually, it does offer them an option to trade a very debilitating condition for mild to severe diabetes,” Makary said.
The study was published in the journal JAMA Surgery in June 2017.