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What you should know / frequently asked questions about TPIAT, Department of Surgery, SUNY Downstate Medical Center

What You Should Know
Based on Frequently Asked Questions

In dealing with chronic pancreatitis, an irreversible and progressive disease that causes chronic pain syndrome, you need to know the following:

  • Once the diagnosis of chronic pancreatitis has been made, the sooner you talk to our team, the sooner we can get involved in your care.

  • Results in terms of achieving insulin-independence, i.e., not being diabetic after TPIAT, are best if the pancreas is not yet destroyed by the disease at the time of surgery. In fact, some of the best results after TPIAT are seen in patients with minimal change disease or small-duct disease.

  • Your chances of being insulin-free after TPIAT are diminished if you underwent pancreatic surgery in the past or if you are already in a pre-diabetic state. Thus, early (self-) referral or by a specialist is key.

  • The procedure takes about 6-10hrs: 4hrs for the removal of the pancreas (total pancreatectomy) and 4hrs for gastrointestinal reconstruction and islet transfusion (islet auto-transplant). Reconstruction entails new connections between the small bowel and the bile duct as well the stomach or duodenum.

  • Your chronic pain syndrome will improve dramatically after surgery and you will notice it as quickly as in the recovery room immediately after surgery. The nagging, unrelenting abdominal and back pain will be replaced by wound pain and continue to improve during your hospital stay. This wound pain is completely different in character and is experienced by all patients undergoing abdominal surgery. In contrast to chronic pancreatitis pain, the wound pain is short-lived and well-controlled with standard pain medication.

  • You will be on an insulin drip during and right after surgery and may continue on insulin injections for some time in order to not stress the islets. As the transplanted islets start functioning, your insulin doses will be reduced.

  • After TPIAT you will remain on pancreatic enzyme supplementation and may require a higher dose.

  • Surgical complications after TPIAT, i.e. after major abdominal surgery, can occur but are rare. Small bowel obstruction as a result of scar tissue occurs at a rate of about 1% per year; hernias and wound infections usually develop in<5% of patients; re-explorations for bleeding, leakages or infections occur in <3%. Complications in regards to the islet transfusion are even more rare: blood clots in the portal vein or liver abscess are highly unusual and presented in the scientific literature as case reports.

  • The average hospital stay without a complication (most patients) is approximately 12 days with a range of 8-16 days.

  • With the assistance of our (or your own) pain specialists, you will be, more likely than not, successfully weaned of narcotics and opioids within several months after TPIAT.

  • You may continue to lose weight over the first 2-4 months after TPIAT. Rather than having 3 big meals a day, you may want to have 4-6 smaller meals/snacks.

  • Despite a good islet yield and high cell viability, it can take several months until insulin-independence is achieved. We do not yet fully understand why there is this delay in function. However, return of islet function varies among individuals and late onset of islet function is not uncommon.

  • If your islets are not functioning at all and you also require high pancreatic enzyme substitution, you may be a candidate for a pancreas transplant from a deceased donor. Our team is very experienced in pancreas transplantation and we will provide guidance to you as what your best options are to become insulin- and enzyme-independent after a failed TPIAT.

  • Our dedicated team will be on your side with whatever issues need to be resolved after TPIAT. Your success is our success and you may become an ambassador to other patients who still do not know the benefits that TPIAT can provide to patients with chronic pancreatitis and chronic pain syndrome.