Total Pancreatectomy with Islet Autotransplantation

This procedure is primarily for patients with severe chronic pancreatitis who haven’t had success with less invasive forms of treatment. TPIAT allows a patient to be treated for the pain of pancreatitis without the repercussions of developing diabetes.

To begin the process, you will meet with one of our subspecialists to review your medical history and records. Our multidisciplinary board members will review your body scans to determine if you are a candidate for this procedure. If approved, we will then contact your insurance carrier to verify benefits and coverage.

Patients express a dramatic improvement in their quality of life after a total pancreatectomy with islet autotransplantation, and most patients that previously were on narcotics to control abdominal pain can wean off of all pain medications. In addition, our most recent analysis demonstrates that approximately 30% of patients do not require any insulin after surgery, and the remaining patients maintain stable glucose control.

As with any surgery, there are some risks and potential complications. Your surgeon will assess and review your specific risks in detail as you prepare for surgery. Risks depend on each patient’s medical and surgical history and current health status and may vary greatly from person to person. Potential complications include:

• Postoperative fluid collections or abscess formation – leaking can occur at the procedure sites and can cause fluid to accumulate within the abdomen. This fluid can sometimes become infected, causing an abscess. Often, these leaks resolve on their own without any intervention. Occasionally, they may need to be drained by placing a tube into the abdominal wall or in the abscess. The tube is removed once the drainage resolves. On rare occasions, another surgery may be required to resolve the problem.
• Delayed gastric emptying – in some instances, the stomach seems to “fall asleep” following surgery. The result is difficulty eating, feeling full quickly, nausea and sometimes vomiting. This will eventually improve on its own, but there is no way to determine how long it may take. Some patients may need to have a temporary feeding tube if they are not able to eat enough on their own.
• Wound infection or breakdown – abdominal incisions can occasionally become infected, or there may be areas that do not completely close by the time the staples are removed. Initially, the incision may appear completely closed and later start seeping drainage, or a small bulge may develop near the incision. This may mean there is a small collection of fluid under the skin. This is easily fixed by gently opening these areas with a cotton swab and then performing packing twice daily until the incision heals from the bottom up. Antibiotics are prescribed if the incision becomes infected. Healing may take several weeks.
• Blood clots/pneumonia – blood clots can occur in either the legs or lungs. Patients are given blood thinners at the time of surgery and compression boots/special stockings are applied after surgery to reduce this risk. Patients are also ordered to be out of bed and walking very soon after surgery to prevent blood clots and other respiratory problems such as pneumonia.

Bleeding or cardiac arrest – Significant bleeding or cardiac arrest are rare complications that may occur after TPIAT.

Here’s what else you can expect with this procedure:

• Estimated length of surgery: 6–10 hours.
• Estimated time in surgical intensive care unit: 48–72 hours.
• Estimated hospital stay: 7–10 days.
• Estimated post-operative recovery: 6–8 weeks