Removal of the tail of the pancreas is called distal pancreatectomy. Diseases that may require surgery include a tumor (neuroendocrine tumor or adenocarcinoma) or persistent pseudocyst formation in the tail of the pancreas (a collection of pancreatic secretions surrounded by a thick wall of tissue).
Preoperative Information
Prior to removal of the tail of the pancreas, you will be asked not to eat anything after midnight prior to your surgery. You will be given specific instructions from your surgeon or anesthesiologist about which medications you should or should not take prior to your surgery. You should not take any blood thinning medications, such as asprin, ibuprofen, Coumadin or plavix at least 5 days prior to your operation. This should be discussed with your surgeon at your preop visit.
You may be prescribed a bowel prep in order to clean the stool from your colon before removal of the pancreas. There are several different types of bowel prep available to prescribe to you, based on the preference of your surgeon. If you are given a bowel prep, it is very important you take the full prep as directed.
In some cases, the spleen may need to be removed along with the tail of the pancreas. If this is so, prior to removal of your spleen and tail of the pancreas, you will be given vaccinations against several bacteria that are more common after splenectomy. These bacteria are normally prevented from causing severe infections by the spleen, and if not properly vaccinated, they can cause severe infection, called overwhelming post-splenectomy sepsis (OPSS), which can be fatal.
Postoperative Information
Elective removal of the tail of the pancreas is performed laparoscopically in most cases. In the event that a larger incision is required, recovery time may be longer.
Activity
You can resume most usual activities gradually beginning shortly after surgery. You should begin walking the night of surgery or the following morning and continue to increase as you are able. Increased activity reduces the risk of blood clots, and improves breathing to prevent pneumonia
Avoid lifting more than 10 pounds for 4 weeks and excessive bending or twisting for 1-2 weeks following surgery. This is to allow healing of the incisions, specifically the fascia (the strongest layer of the abdomen wall) and decrease the risk of developing a hernia.
Avoid driving until you no longer need narcotic pain medication and you feel you can make rapid movements unimpaired by pain. Driving while taking narcotics can impair your ability to drive safely.
You should be able to return to work 1-3 weeks after surgery.
Wound Care
A small gauze and clear tape dressing is typically placed over each incision. These dressings can be removed 48 hours (2 days) after the operation. Below this dressing are small brown or white pieces of tape (called Steri-Strips); these will fall off on their own within 1-2 weeks or be removed at your follow-up visit with your surgeon. If your surgeon gives you specific instructions other than this, please follow those instructions.
You may shower after 48 hours (after the gauze and clear tape dressing is removed). It is okay to get soap and water on the incisions. Pat the area dry. It is not recommend that you submerge underwater (in a bathtub, pool, or hot-tub) for at least two weeks post-op.
If your distal pancreatectomy was done as an open procedure, you will probably have a long white dressing or gauze and tape dressing over your incision. This dressing may be removed 48 hours (2 days) after the operation and will probably be removed before you leave the hospital. Your incision will probably be closed with small metal staples. These will be removed at your postop visit, usually 10-14 days after your operation. If you are in the hospital more than a week, these may be removed before you go home.
If you notice drainage from your incisions, particularly if it is thick and foul-smelling or associated with a fever, contact your surgeon.
If you notice redness around your incisions, especially if it is getting worse or associated with drainage or a fever, contact your surgeon.
Medications
Pain Management
Pain is typically just around the site of incisions, but after laparoscopic surgery, you may have more general abdominal pain or even shoulder pain due to the air used to inflate your abdomen during the surgery. Pain from air inflation will go away in 24 to 48 hours.
You will be discharged with pain medication, typically a mild to moderate strength narcotic. Take as needed and as prescribed. You may also take over-the-counter medications such as ibuprofen for pain. Most narcotic medications prescribed are combined with Tylenol (acetaminophen) and you should not take additional Tylenol if you are taking a narcotic medication that already contains Tylenol.
Pain after an open distal pancreatectomy can be significant. You will most likely be placed on IV narcotics using a pump (PCA � patient controlled analgesia), which allows you to press a button for additional medication when you need it. This will be weaned off within a few days of your operation and you will start oral pain medications. It is very important to us that your pain be well controlled. Your pain should be controlled well enough for you to begin getting out of bed the morning after surgery and for you to perform deep breathing exercises. If you have pain that is not well enough controlled to allow you to walk or breathe deeply, talk to your surgery team. You may need to have your pain medications changed or increased.
Other Medications
You may be prescribed a stool softener when you go home. Pain medications can cause constipation and a stool softener may help. You may also be given nausea medication if you experience nausea or vomiting from taking your pain medication.
Home Medications
Unless otherwise instructed, you should be able to resume your usual home medications the night of or the morning following your surgery
More detailed information on commonly prescribed medications
Diet & Bowel Care
You may resume your usual diet as you feel able unless otherwise instructed. You may have some abdominal bloating or mild nausea after your operation, so eat slowly and only what you can tolerate. Your appetite may be less than usual but typically returns to normal within a week or two. Be sure to drink plenty of liquids (6-8 glasses of water or juice each day).
It is common to have some constipation after surgery, especially when taking narcotic pain medications. You will probably be prescribed a stool softener when you are discharged. If you are having trouble moving your bowels after surgery (if your stool is hard or you have to strain excessively) you may need a laxative. Over the counter medications can treat this well. Senna, Miralax, or dulcolax are some of the most common and are available at most drug stores or grocery stores. Take as directed.
If you experience problems having a bowel movement AND have abdominal bloating, nausea or vomiting, and not passing gas, call your doctor.
Follow Up
You will be given a date and time to see your surgeon following surgery. If you are discharged late in the day or over the weekend, you will be given a number to call the following business day for an appointment. If you are having trouble making an appointment, call your doctors' office directly for assistance.
Call Your Doctor If
Although not frequent, some people may develop abdominal pain with low-grade fevers and increases in white blood cell count and platelets as a result of clots that can form in the remaining portion of the vein draining the spleen as well as the portal vein after splenectomy. If this happens, a CT scan or ultrasound of the abdomen will confirm the diagnosis of portal vein thrombosis. This condition can occur months after removal of the spleen and treated with blood thinners such as Coumadin.
Contact Information
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