Surgery & Endoscopic Procedures for Pancreatitis
Sometimes, acute pancreatitis is caused by gallstones that block the duct through which digestive enzymes leave the pancreas. NYU Langone pancreatic surgeons can perform an endoscopic procedure to remove the blockage, allowing the pancreas to function normally. Our doctors may also perform surgery to relieve severe complications of acute pancreatitis, such as infection and tissue death, also called necrosis.
For chronic pancreatitis, surgery may be recommended if chronic inflammation has caused a blockage in the pancreatic ducts. Surgery can help prevent further damage to the pancreas and alleviate symptoms like persistent pain.
Pancreatic surgeons at NYU Langone work as a team with imaging specialists using advanced diagnostic techniques to locate the areas of the pancreas where damage has occurred. For many people, surgery can be performed using minimally invasive, or laparoscopic, techniques, which require smaller incisions. General anesthesia is typically used for all of the following procedures.
Endoscopic Retrograde Cholangiopancreatography
For acute pancreatitis caused by gallstones lodged in the common bile duct, doctors may perform a procedure called endoscopic retrograde cholangiopancreatography to remove the stones and prevent further inflammation in the pancreas.
During the procedure, your doctor glides an endoscope with a tiny video camera on the end through the mouth, down the throat and stomach, and into the small intestine, adjacent to the pancreas.
Using the endoscope, your doctor finds an opening in the intestine that connects to the pancreatic and bile ducts. He or she places a catheter or small tube in the opening and injects a contrast dye. The dye enhances images of the pancreatic and bile ducts on X-rays. This helps the doctor identify the gallstones causing the blockage so he or she can remove them.
The doctor then makes a small incision where the pancreatic duct and bile duct meet—an area called the ampulla of Vater—and inserts surgical tools, such as a balloon catheter or a basket, to retrieve the stone or stones. If there are many gallstones in the duct, sometimes doctors need to perform two procedures to remove all of them. They may place a temporary plastic tube called a stent in the duct to relieve the obstruction in between procedures.
When this procedure is performed, our specialists often also recommend a cholecystectomy, in which surgeons remove the gallbladder. This prevents pancreatitis from recurring.
After an endoscopic retrograde cholangiopancreatography, you may remain in the hospital for three to four hours as you recover. Immediately after the procedure, you may feel bloated or nauseous. Your doctor may advise you to rest for the remainder of the day, but most people can resume normal activities the following day.
Debridement and Drainage
If acute pancreatitis has caused severe complications, such as an infection that doesn’t respond to antibiotics, NYU Langone surgeons may perform a debridement and drainage procedure to remove infected pancreatic tissue or necrosis. This procedure also allows doctors to drain any fluid from the pancreas that has accumulated as a result of an infection. They may create a new drainage pathway in the pancreas to restore normal function.
Doctors at NYU Langone can perform debridement and drainage using laparoscopic surgical techniques, traditional “open” surgery, or robotic-assisted surgery. The technique your surgeon uses depends on where the damage is located in the pancreas, as well as your health.
Pancreatic surgeons at NYU Langone also specialize in advanced techniques, such as video-assisted retroperitoneal debridement, which involves operating through the back of the body to repair damage to the distal, or “tail” end, of the pancreas.
Pancreatic Cyst Gastronomy
Pancreatic cyst gastronomy is a drainage procedure that an advanced endoscopist or surgeon may use if a pancreatic pseudocyst—a fluid-filled sac—develops in the abdomen and causes symptoms such as pain, the sensation of a full stomach, or vomiting. This may occur as a complication of acute pancreatitis if inflammation and swelling cause the ducts to become damaged. Our experts usually perform this procedure using an endoscopic technique.
Some pseudocysts may go away on their own, but many require treatment to avoid more serious complications, such as infection or an abscess. In severe circumstances, a pseudocyst may become necrotic, meaning it contains dead tissue.
If you experience symptoms such as persistent abdominal pain or bloating, NYU Langone doctors usually can drain a pancreatic pseudocyst using an endoscopic approach or a minimally invasive, robot-assisted laparoscopic approach. If necessary, our surgeons or gastroenterologists may also remove any dead tissue, a procedure called a necrosectomy.
Surgery for Chronic Pancreatitis
Doctors may recommend surgery for people with chronic pancreatitis when the organ can’t drain pancreatic fluids properly due to tissue scarring. Your surgeon can create a new duct, or passageway, to allow the fluid to drain and reduce inflammation. He or she may also remove scarred or diseased tissue.
NYU Langone doctors use different surgical approaches based on the type of damage and where it appears in the pancreas.
A Puestow procedure is used to treat damage to the middle and end portions of the pancreas, also referred to as the body and tail. In this surgery, surgeons open the main pancreatic duct, which runs along the body of the pancreas, from end to end, and attach a portion of the pancreas and the duct directly to the small intestine—a technique called lateral pancreaticojejunostomy.
In a Frey’s procedure, damaged tissue is removed from the head of the pancreas, the widest part that sits toward the center of the abdomen. Surgeons may also perform a lateral pancreaticojejunostomy with this procedure to widen the connection between the pancreas and small intestine.
Both procedures can be performed at NYU Langone through laparoscopic, open, or robotic-assisted methods.
If acute pancreatitis has led to severe infection and necrosis, or dead tissue, doctors may recommend a resection, or removal, of the diseased portion of the pancreas. Doctors may also recommend resection for people with chronic pancreatitis if the condition has progressed enough to cause severe tissue damage.
Doctors at NYU Langone may perform a distal pancreatectomy to remove portions of the body and tail of the pancreas, or a pancreaticoduodenectomy, also called a Whipple procedure, to remove damaged areas of the head of the pancreas. They may also remove the gallbladder at the same time, preventing new gallstones, which can block the ducts.
What to Expect After Surgery
Recovery time after surgery varies based on the procedure and your health. Some people may require supportive care in the hospital for weeks or longer until their condition stabilizes and the pancreas begins to function normally. During this time, NYU Langone’s intensive care specialists and nursing team carefully monitor you and provide supportive care, including pain management as necessary.