The surgical procedure and what is removed
Over the years there have been a number of centres around the world that regularly perform total pancreatectomy combined with islet autotransplantation for chronic pancreatitis.
This procedure allows the islets to be isolated (separated) from the diseased pancreas immediately after it has been removed in the operating theatre. The islet cells are then separated from the diseased pancreas and given back to the you by injecting them into the liver.
A total pancreatectomy (removal of the pancreas) is performed during open surgery through a large cut (incision) across the top of the abdomen. Sometimes the spleen has to be removed too.
As soon as the pancreas is removed, it is taken to a dedicated cell isolation laboratory which is in the Centre for Life. Specialised enzymes (proteins) are then used to digest the gland and separate out the islets, which are clusters of cells which produce insulin (which keeps sugars low) and the hormones glucagon and pancreatic polypeptide (which keep sugars high).
The islet cells are then processed (purified if necessary) and returned to the operating room as quickly as possible. This process can take anything from 4-6 hours.
While the pancreas is being processed the surgeon reconnects the bile tube and the bowel and inserts a tube into a suitable vein ready for the injection of the islets into the liver. Reconstructions may vary depending on the extent of any previous surgery.
After the islets have been injected into your liver, in this new and healthy environment they can recover from the isolation process and develop a new blood supply. With a new blood supply they resume their production of the necessary insulin and hormones to maintain normal blood sugar levels.
What are the potential results of surgery?
Patients who have undergone this surgery have experienced a dramatic improvement in their quality of life after the procedure.
In the most successful cases, patients are insulin-free with normal glucose tolerance and have excellent relief of abdominal pain.
The remaining patients have usually required minimal insulin to treat high blood sugars (hyperglycaemia) or have easy to control blood sugars. However not every patient is a success as some patients may develop a complication from surgery and some still have abdominal pain. This amounts to about 30% (3 in 10) of patients. Nevertheless it is important to mention that within this 30% the extent of variation is wide in terms of seriousness of complications and improvement in quality of life.
For example, most patients have been successfully weaned off all their painkillers (often morphine based) usually between six months to a year as this has to be done in a controlled manner, others have greatly reduced the need for painkillers but from time to time may still have episodes of pain.
Combining the total pancreatectomy with islet autotransplantation allows a patient to be treated for the pain of pancreatitis without the very serious side-effects of a total pancreatectomy, including “brittle diabetes” when a person’s blood sugar levels often swing quickly from high to low and from low to high which makes it very difficult to control.
Alternatives to having the transplant would include 3-4 times daily insulin injections with regular blood monitoring or a continuous insulin infusion pump if deemed appropriate.
Having an islet autotransplant is the only way to become insulin independent after total pancreatectomy.
