Success with first 20 patients undergoing minimally invasive pancreatic transplant surgery

June 29, 2017

Surgeons at Johns Hopkins Medicine report that their first series of a minimally invasive procedure to treat chronic pancreas disease, known as severe pancreatitis, resulted in shorter hospital stays, less need for opioids and fewer complications, compared with standard surgical approaches.

A report of the case series, published in the June print edition of JAMA Surgery, demonstrates that compared with other surgical approaches, laparoscopic total pancreatectomy with islet cell autotransplantation (TPIAT) may be an ideal option for some with pancreatitis. The laparoscopic approach to TPIAT was pioneered and first performed at The Johns Hopkins Hospital.

"In an era of opioid addiction, performing a major operation through a minimally invasive technique can mean less pain for patients, reducing the need for opioids and their complications," says Martin Makary, M.D., M.P.H., professor of surgery at the Johns Hopkins University School of Medicine and the paper's senior author.

Every year, about 210,000 people in the United States are diagnosed with chronic inflammation of the pancreas, usually due to genetic mutations, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Most of these patients experience long-term, difficult-to-manage pain. Medical treatments such as placing a stent in the pancreas often fail, leaving patients with debilitating pain the surgical option of completely removing the pancreas and "autotransplanting" their own (needed to create insulin and control blood sugar) into their liver.

Makary explains that such operations relieve the underlying problem and enable some patients to live pain-free lives. TPIAT is traditionally performed by opening a long incision in the abdomen to reach the pancreas and the liver. In recent years, less invasive or "minimally" invasive operations have been developed, including the use of a laparoscope inserted through a small incision into the abdomen and through which a surgeon can introduce and manipulate instrument "hands" and small devices to perform the procedure.

Benefits of laparoscopic approaches, Makary notes, can include vastly reduced risk of surgical wound and other infection, a quicker recovery and better pain management.

For the current clinical study, Makary and his team offered 20 patients with chronic pancreatitis the laparoscopic TPIAT operation between Jan. 1, 2013 and Dec. 31, 2015 at The Johns Hopkins Hospital. The average operating time was 493 minutes, and islet isolation took an average of 185 minutes.

The average length of hospital stay was 11 days, and 90 percent (18 of 20) patients experienced a decrease or complete resolution of pain by their six-month follow-up appointments. Sixty percent (12 of 20) of patients no longer required opioid therapy by their six-month follow-up.

The average decrease in score for all patients postoperatively was 33.25, on a scale from 0 to 100.

Compared with results of four previous studies of other for TPIAT, this first series of laparoscopic TPIAT saw a shorter average operative time (average of 493 minutes, compared with 637.2, 533 and 712 minutes), islet isolation time (average of 185 minutes, compared with more than 250, 240, 270 and 272.6 minutes for the 3 studies that provided data), length of stay (11 days, compared with 16, 12.6 and 12.6 days for the 3 studies that provided data) and quicker return to work.

"Chronic pancreatitis can be a very painful and debilitating condition. Careful patient selection can match the right candidates to this new minimally invasive surgical therapy," says Makary.

Explore further: Islet cell transplantation after pancreas removal may help preserve normal blood sugar

More information: Caleb J. Fan et al, Laparoscopic Total Pancreatectomy With Islet Autotransplantation and Intraoperative Islet Separation as a Treatment for Patients With Chronic Pancreatitis, JAMA Surgery (2017). DOI: 10.1001/jamasurg.2016.5707

Related Stories

Islet cell transplantation after pancreas removal may help preserve normal blood sugar

December 10, 2014
Surgery to remove all or part of the pancreas and then transplant a patient's own insulin-producing islet cells appears to be a safe and effective final measure to alleviate pain from severe chronic pancreatitis and to help ...

Innovations in the management of chronic pancreatitis

May 19, 2017
Chronic pancreatitis (long-standing inflammation of the pancreas) (CP) is a challenging disease for health care practitioners because it is difficult to diagnose and treat. Although its annual incidence rate in the United ...

UA surgeons first to remove whole pancreas combined with auto-islet transplant

August 27, 2012
(Medical Xpress)—University of Arizona surgeons at The University of Arizona Medical Center have performed the world's first fully robotic total pancreatectomy with a successful simultaneous autologous islet transplant ...

Minimally invasive surgery underused at many US hospitals

July 8, 2014
Hospitals across the country vary substantially in their use of minimally invasive surgery, even when evidence shows that for most patients, minimally invasive surgery is superior to open surgery, a new study shows. The finding ...

Use of minimally invasive surgery could lower health care costs by hundreds of millions a year

March 25, 2015
A new analysis of surgical outcomes nationwide concludes that more use of minimally invasive surgery for certain common procedures can dramatically reduce post-operative complications and shave hundreds of millions of dollars ...

Laparoscopic anti-reflux operation for GERD linked to fewer postoperative complications

January 26, 2017
Patients with gastroesophageal reflux disease, known as GERD, who undergo laparoscopic anti-reflux operations compared with traditional "open" operations suffer fewer postoperative complications, experience faster recovery, ...

Recommended for you

One weight-loss surgery shows lasting results

September 21, 2017
(HealthDay)—Obesity surgery can have long-lasting effects on weight and the risk of developing type 2 diabetes and high blood pressure, a new study finds.

Hold the phone: An ambulance might lower your chances of surviving some injuries

September 20, 2017
Victims of gunshots and stabbings are significantly less likely to die if they're taken to the trauma center by a private vehicle than ground emergency medical services (EMS), according to results of a new analysis.

Surgeons have major influence on breast cancer treatment

September 13, 2017
A woman's choice of surgeon plays a significant role in whether she's likely to receive an increasingly popular aggressive breast cancer surgery.

Some thyroid cancer patients can safely delay surgery

September 4, 2017
Most people diagnosed with cancer want to start treatment as soon as possible, for fear that delaying care will allow their tumor to grow out of control.

Obese people lack cells with satiety hormones

August 29, 2017
Individuals with severe overweight have an inhibited sense of satiation - they release fewer satiety hormones than people of normal weight. The reason: the responsible cells in the gastrointestinal tract of obese people are ...

Anesthesia and surgery during infancy may impact white matter during childhood

August 24, 2017
General anesthesia and surgery in otherwise healthy infants under the age of 1 year old could be associated with decreases in the amount of white matter in the brain, as well as reductions in the remaining white matter's ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.