Comprehensive pancreatic care — acute pancreatitis management, chronic pancreatitis surgical treatment, pancreatic pseudocyst drainage, and pancreatic tumour surgery — by Dr. Hamikchandra Patel, Fellowship-trained surgical gastroenterologist, at Shaleen Multi Speciality Hospital, Sola.
Understanding the Pancreas
The pancreas is a critical gland with two essential functions: exocrine — producing digestive enzymes (lipase, amylase, protease) that enter the duodenum to break down food; and endocrine — producing insulin and glucagon that regulate blood glucose. When the pancreas is damaged by inflammation, stones, tumours, or autoimmune processes, both functions can be severely impaired.
Pancreatitis — inflammation of the pancreas — ranges from mild self-limiting acute pancreatitis (managed medically) to severe necrotising pancreatitis requiring intensive care, radiological intervention, and sometimes surgery. Chronic pancreatitis — recurrent inflammation leading to gland destruction — causes permanent exocrine insufficiency, endocrine failure (diabetes), and chronic pain requiring surgical decompression or resection.
Pancreatic surgery is among the most technically demanding in abdominal surgery. Dr. Hamikchandra Patel's Fellowship in Surgical Gastroenterology provides the specialised training to manage pancreatic disease appropriately — from conservative pancreatitis management to complex pancreatic resection in coordination with oncology.
Gallstone pancreatitis — triggered when a stone temporarily or permanently blocks the ampulla of Vater — accounts for 40–50% of acute pancreatitis cases in India. Treatment includes supportive care followed by laparoscopic cholecystectomy (within the same admission for mild pancreatitis) to prevent recurrence.
Chronic heavy alcohol consumption is the most common cause of chronic pancreatitis in India. Even a single heavy drinking episode can trigger acute pancreatitis. Complete alcohol cessation is the most important intervention for alcohol-related pancreatic disease.
Complex pancreatic conditions — particularly pancreatic cancer — require multidisciplinary management involving surgical gastroenterology, medical oncology, interventional radiology, and endocrinology. Dr. Gastro coordinates this team approach for optimal patient outcomes.
Pancreatic Conditions We Treat
From acute pancreatitis to complex pancreatic surgery — comprehensive pancreatic care by a Fellowship-trained specialist.
Sudden pancreatic inflammation — ranging from mild (resolves with 3–5 days of supportive care) to severe necrotising pancreatitis requiring ICU management, CT-guided drainage of infected necrosis, and surgical necrosectomy. Most common causes: gallstones and alcohol.
Progressive inflammatory destruction of the pancreas — causing permanent exocrine insufficiency (maldigestion, steatorrhoea), endocrine failure (diabetes mellitus), and chronic pain. Surgical options: lateral pancreaticojejunostomy (Puestow procedure) for ductal dilation, and partial pancreatectomy for localised disease.
Fluid collection in or around the pancreas following pancreatitis — not a true cyst (no epithelial lining). Managed conservatively if small and asymptomatic; large or symptomatic pseudocysts require endoscopic (EUS-guided), radiological, or surgical drainage.
Pancreatic ductal adenocarcinoma — among the most aggressive malignancies. Surgical resection (Whipple procedure or distal pancreatectomy) offers the only chance of cure for resectable tumours. Neuroendocrine tumours (NETs) are managed with resection, ablation, or medical therapy depending on type and grade.
Treatment Procedures
The standard surgical resection for pancreatic head cancer, duodenal and periampullary tumours — removing the head of the pancreas, duodenum, proximal jejunum, gallbladder, and common bile duct, with complex reconstruction. Among the most demanding abdominal procedures — performed only by highly specialised surgeons.
Puestow procedure — the pancreatic duct is opened longitudinally and anastomosed side-to-side to a loop of jejunum, providing permanent decompression of the dilated pancreatic duct. Dramatically reduces chronic pain in patients with main pancreatic duct dilation (>5mm).
Endoscopic ultrasound (EUS)-guided transmural drainage creates a permanent connection between the pseudocyst and the stomach or duodenum — the preferred minimally invasive approach. Surgical cystgastrostomy or cystjejunostomy is reserved for cases not suitable for endoscopic drainage.
Treatment Journey
Serum amylase, lipase, LFTs, bilirubin, CA 19-9 tumour marker, and fasting glucose. Detailed history of alcohol use, gallstones, medications, and family history. Physical examination for jaundice, abdominal tenderness, and mass.
Ultrasound identifies gallstones and pancreatic dilation. Contrast-enhanced CT assesses severity of pancreatitis (Balthazar score), identifies necrosis, pseudocysts, and tumours. MRCP provides bile and pancreatic duct detail non-invasively. EUS provides fine-detail of pancreatic lesions and enables guided biopsy.
Mild acute pancreatitis: IV fluids, analgesia, bowel rest, early oral feeding when tolerated, and cholecystectomy before discharge. Infected necrosis: CT-guided drainage and step-up surgical debridement if needed. Pseudocyst: EUS-guided drainage. ERCP for pancreatic duct stones.
For chronic pancreatitis with dilated duct: lateral pancreaticojejunostomy. For pancreatic cancer: neoadjuvant chemotherapy (if borderline resectable), followed by Whipple procedure or distal pancreatectomy as appropriate. Laparoscopic approach for distal pancreatectomy where feasible.
Pancreatic enzyme replacement therapy (PERT) for exocrine insufficiency. Insulin or oral hypoglycaemics for pancreatogenic diabetes. Nutritional rehabilitation — high-protein, low-fat diet and fat-soluble vitamin supplementation. Oncology follow-up for pancreatic cancer patients.
Patient Questions
Expert gastrointestinal and laparoscopic surgery at Shaleen Multi Speciality Hospital, Sola, Ahmedabad. Transparent consultation, honest advice, and patient-centred care always.
