Rare surgery performed to remove pancreas, prevent diabetes and ease pain of chronic pancreatitis

In a 12-hour, dual-stage surgery known to be performed at only two other centers in the U.S., doctors at the University of Alabama at Birmingham (UAB) on Tuesday returned a patient's own insulin-producing cells to him after surgically removing his pancreas to eliminate constant, severe pain from chronic pancreatitis.

The patient, Leonard Stewart, 47, of Panama City, Fla., remained anesthetized in the operating room at UAB Hospital through removal of his entire pancreas and the hours-long wait for the pancreatic islet cells to be processed in a specialized UAB laboratory. The cells were then returned to the operating room and infused into the patient's liver, where they have begun to produce insulin.

Few hospitals have the technologically sophisticated facilities necessary to isolate and purify the pancreatic islet cells either from a cadaver donor for transplantation or, as in this case, for infusion back into the same patient.

The removal of the entire pancreas is an accepted, although radical last-resort, surgery to give relief from pain, usually from inflammation of pancreatitis. In the past, such surgery might eliminate the pain but would leave the patient with severe, poorly-controlled diabetes, since the insulin-producing islets of Langerhans would necessarily be discarded along with the rest of the organ. Patients without functioning islet cells have to take insulin for life. Retrieving and relocating the natural insulin-producing cells from the pancreas saves patients from the complications of severe, poorly-controlled diabetes. Loss of the other major function of the pancreas, production of digestive enzymes, is dealt with by taking the enzymes as a dietary supplement.

Leading the complex operation were Drs. Selwyn M. Vickers, Devin E. Eckhoff and Juan L. Contreras. Vickers, who removed the pancreas, directs a clinic for the management of chronic pancreatitis, is chief of gastrointestinal surgery and co-director of the UAB Pancreaticobiliary Center. Eckhoff is director of the division of transplantation, and directs the University's islet cell transplant program, which uses pancreatic cells from brain-dead patients to cure insulin-dependent diabetics. Contreras is co-director of the islet transplant program. The patient was in intensive care at UAB Hospital for two days following the surgery, and will be in the hospital until sometime next week, doctors said.

Stewart's chronic pancreatitis developed four years ago as the result of a congenitally malformed pancreatic duct that closed down following removal of his gallbladder at a Louisiana hospital. Three prior operations and several procedures to place stents in the pancreatic duct failed to provide relief. The pain of chronic pancreatitis is known to be constant and extremely debilitating. Facing a life of suffering from the condition, Stewart chose the alternative of total removal of the pancreas and of autologous islet cell transplantation.

The procedure has been done previously; the first case was 16 years ago at the University of Minnesota, and the patient still survives. Only a few other cases were attempted, and results were not uniformly good, so the procedure fell out of favor until recently, when new advances in cadaveric islet cell transplantation made outcomes more favorable.