Surgery to Relieve the Pain of an Inflamed Pancreas (Pancreatitis)

#TPIAT #pancreatectomy #pancreatitis
MEDICAL ANIMATION TRANSCRIPT: If your child has severe pain from a condition called pancreatitis, a total pancreatectomy with islet autotransplantation, or TPIAT, may help. The main goal of TPIAT is to relieve the pain caused by an inflamed pancreas. TPIAT has two stages. In stage one, the pancreas, spleen, gallbladder, and most of the duodenum are removed. And the surgeon will reconstruct the bile duct and stomach drainage, and remove the appendix. In stage two, islets from your child’s pancreas, which contain insulin-producing beta cells, will be transplanted into the liver. This may prevent insulin-dependent diabetes. To begin, an incision will be made above the belly button. Part of the large intestine, or colon, will be moved out of the way, and the pancreas, spleen, and duodenum will be freed from surrounding tissue. Then, the surgeon will divide the bile duct, cystic duct, and cystic artery and remove the gallbladder. Next, the right gastroepiploic artery will be divided. And the first part of the small intestine, or duodenum, will be divided just beyond the pylorus, which is the opening from the stomach into the duodenum. The gastroduodenal and splenic arteries will be identified and freed from surrounding tissue. The end of the duodenum will be freed from its supporting tissue, and the small intestine will be divided just beyond the duodenum. In some cases, the inferior mesenteric vein may be divided. And the pancreas will be freed from the portal vein underneath it. Next, the gastroduodenal artery and splenic artery will be divided, as well as the splenic vein. At this point, the pancreas will be removed, along with the spleen and most of the duodenum. The pancreas will be passed to the islet team to begin the process of islet isolation. While the islets are isolated, the surgeon will reconnect the small intestine in two limbs, or segments, to allow normal digestion. The first limb will be sutured to the bile duct. Next, this limb will be divided to create a second limb. The end of the first limb will be sutured to the side of the second limb. Then, the top of the second limb will be sutured to the remaining duodenal end. And the appendix will be removed. This completes the reconstruction of the digestive tract. During stage two, the isolated islets will be infused slowly into the liver through its blood supply. At the end of the procedure, feeding and drainage tubes will be placed, and the incision will be closed. After the procedure, your child will be closely monitored in the pediatric intensive care unit. For more information, talk to your healthcare practitioner.
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