What is the pancreas?
The pancreas is a complex organ located deep in the abdomen that has many functions. It produces digestive enzymes, which drain through the pancreatic duct into the duodenum, which is the first part of the small intestine. Although this portion of the pancreas (the exocrine portion) can develop benign or malignant tumors, they are not specifically discussed here. The pancreas also has specialized cells which produce a number of endocrine hormones. The information to follow concentrates mostly on this "endocrine pancreas."

Only about 5% of the mass of the pancreas is composed of endocrine cells which are also called "islet cells" since they are clustered together like small islands. These cells secrete important hormones into the bloodstream. Some of these hormones are insulin, glucagon, gastrin, and vasoactive intestinal peptide (vip).

When is endocrine pancreatic surgery needed?
If a tumor of these islet cells occurs, it may overproduce one or more of these hormones. These tumors are often named by their hormone plus the suffix "oma." therefore, an insulinoma overproduces insulin and will cause low blood sugar (hypoglycemia). A glucagonoma overproduces glucagon and will cause high blood sugar (diabetes) and characteristic skin changes. A gastrinoma secretes gastrin and may cause excess stomach acid secretion, ulcers, and diarrhea. A vipoma is a very rare tumor which secretes vasoactive intestinal peptide and causes a high-volume watery diarrhea with electrolyte imbalances.

Even very small tumors less than 1 cm in size can cause serious problems related to their hormone production. Depending on the type of tumor cells, they may also be likely to behave in a malignant fashion (spreading as a cancerous growth). These are the important indications for having endocrine pancreatic surgery.

How is surgery for the endocrine pancreas usually done?
Operations on the pancreas typically require an abdominal incision with some dissection of the stomach and intestines to expose the pancreas located deep within the abdomen. Many of these endocrine tumors may be dissected out of the substance of the pancreas, but in some cases may require partial removal of the pancreas (pancreatectomy).

Pancreatic surgery encompasses a wide variety of surgical procedures concerning the pancreas (a gland located behind the stomach just below the liver). Disorders of pancreas can be divided onto those caused by tumors (benign or malignant) and those caused by inflammation (acute or chronic).The majority of surgical procedures performed on the pancreas involve resection (removal) of the portion that is involved in the disease process. Prior to any operation on the pancreas the patient undergoes testing and is evaluated by multidisciplinary team of physicians. The management approaches to acute and chronic pancreatitis are different and may not necessarily involve surgical intervention. Often excellent results can be achieved through medical management. A major pancreatic resection takes approximately 4-6 hours and in most cases is performed without blood transfusion. The post-operative hospital stay is about 7 days and complete recuperation time is expected in 6 weeks. In properly selected patients, excellent operative results and future quality of life are achieved.