Pancreas opened inside out. 50 year old chronic pancreatitis requiring repeated admissions to hospital with pain abdomen. Developed diabetes over last few years. Met me 2 years ago, advised surgery but disappeared. Strongly motivated by few against surgery but when it was beyond his means to tolerate pain ,landed with me begging for surgery. That is so in case of chronic pancreatitis I have seen over years being managed this way when surgery can provide decent relief of pain and prevent many complications.
Here lies pancreas opened inside out with many pseudocysts opened into duct. Also had biliary obstruction with jaundice( that was what a scared him more than pain). Bile duct and pancreatic ducts were drained into small intestine ( jejunum).
1 month post-op , no analgesics, diabetes well controlled on diet.
Gall Bladder cancer with jaundice strikes high possibility of unresectability in surgeons mind.
We attempted resection in 68 year old male patient with blockage just upto confluence of right and left hepatic ducts. As expected artery to right liver was going through tumor although preop. CT did not show it. Hepatic artery resection and reconstruction ( with the help of Dr. Deepak Puri, CTVS colleague) and converting three hepatic ducts into one for easy joining to intestine( jejunum- hepaticojejunostomy), made it ppossible to have complete resection of tumor with negative margins.
Complete resection is one and only option for best survival in patients with cancers of liver, bile duct , gall bladder and pancreas. This type of planning and team work has helped us made many unresectable looking tumors into resectable ones.