Surgery of endocrine organs Surgery of the pancreas Dr. T. Németh Tibor, DVM, PhD, DipECVS Assoc. Professor and Head of Surgery Surgical anatomy Surgi

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1 Surgery of endocrine organs Surgery of the pancreas Dr. T. Németh Tibor, DVM, PhD, DipECVS Assoc. Professor and Head of Surgery Surgical anatomy Surgical anatomy Physiological overview Exocrine function (acinus) neutralisation of stomach content Digestion of protein, fat and carbonhydrate Endocrine function (Langerhans islands) inzulin, glucagon, somatostatin, PP Surgery of the pancreas - biopsy - drainage

2 Surgery of the pancreas - biopsy - drainage - biopsy pancreatic mass pancreatitis, tumour pancreatic cyst fine needle aspiration (!) incisional biopsy gentle manipulation (!) biopsy: dissection dissection-ligation ligation technique biopsy: Guillotine technique - biopsy - biopsy

3 - biopsy Surgery of the pancreas - biopsy - drainage - drainage - omentalisation (pancreatic cyst) Diagnostics septic state laboratory US (X-ray) - drainage - omentalisation exploration and isolation of abscess/cyst evacuation, flushing omentalisation postoperative management (pancreatitis)

4 - omentalisation - omentalisation - omentalisation - omentalisation Surgery of the pancreas - biopsy - drainage necrosis injury smaller cyst, abscess, tumour tumour (insulinoma) exploration, thorough intraop. diagnsotics partial pancreatectomy total pancreatectomy

5 Partial pancreatectomy Partial pancreatectomy Partial pancreatectomy Partial pancreatectomy Traumatic rupture Partial pancreatectomy necrosis injury smaller cyst, abscess, tumour Insulinoma Electrosurgical tissue sealing exploration, thorough intraop. diagnsotics partial pancreatectomy total pancreatectomy

6 carcinoma carcinoma - carcinoma Total pancreatectomy (cholecystoenterostomy + Billroth II.) csepleszáttét májáttét Complications autodigestion chemical peritonitis Diabetes Mellitus Exocrine Insuffitiency Gastrojejunostomy artificial nutrition Keeping pancreas inactive inactive (pancreatitis pancreatitis, pancreas- surgery) Technique via laparotomy (or via endoscopy/laparoscopy laparoscopy) Foley-catheter percutaneous removal

7 Gastrojejunostomy Surgery of the adrenal gland Anatomy bilateral organ at cranial pole of kidneys phrenicoabdominal a. and v. cortex and medulla Physiological overview Adrenal cortex corticosteroids (glyco-, mineralocorticoids) androgene steroids oestrogene steroids Adrenal medulla catecolamins stress unilateral tumour adenoma, carcinoma (Cushing s disease) pheochromocytoma (hypercatecholemia hypercatecholemia) operability (involvement of caudal v. cava) accurate diagnosis (endocrinological endocrinological, morphological) operability accurate

8 Adenoma Preoperative medical management Cushing s disease: Trilostan Pheochromocytoma: blood pressure reduction (α- and β-blockers blockers) paracostal (or laparoscopy!): without v.cava involvement midline laparotomy: in case of v.cava involvement ligature of phrenicoabdominal a. and v. Postoperative management glycocorticoid-substitution (parent parent. hydro-cortisone cortisone, dexametasone then oral pred.) endocrinological management (ACTH stim.test) Adenoma Adenoma Adenomacarcinoma/v. cava involvement Preoperative management Cushing s disease: medical treatment (Trilostan Trilostan) Pheochromocytoma: blood pressure reduction (α- and β-blockers blockers) paracostal (or laparoscopy!): without v.cava involvement midline laparotomy: in case of v.cava involvement ligature of phrenicoabdominal a. and v. Postoperative management glycocorticoid-substitution (hydro hydro-cortisone cortisone, dexametasone) endocrinological management (ACTH stim.test)

9 Surgery of the thyroid gland feline hyperthyroidismus canine thyroid-tumour tumour (euthyroidism euthyroidism!) Diagnostics hyperthyroidism (cat cat!!!) mobile mass in the boundary between the upper and middle third of the neck differential-diagnostic diagnostic (salivary gland, lymphonode, chemodectoma) fine needle aspirate/cytolology (bleeding bleeding!) US scintigraphy Thyroid-scintigraphy Left thyroid Right thyroid background Positioning Extracapsular

10 Extracapsular Extracapsular parathyroid Extracapsular Modified extracapsular Complications postoperative hemorrhage/hematoma hematoma seroma recurrence phlegmone/abscess hypocalcemia (+ parathyroidectomia!)