Bypass surgery may be carried out either shortly after diagnosis (when during an operation to remove the tumour it is found that the tumour has progressed slightly more than suggested by the pre-operation staging investigations), or at a later stage when a blockage occurs making you sick because your stomach is not emptying properly. When this occurs after initial treatment, it is caused by a blockage at the outlet of the stomach that joins the duodenum (first part of the small bowel). This blockage is called “gastric outlet obstruction”
The human digestive system
This operation is usually carried out when, during a planned attempt to remove the tumour, your surgeon finds that taking out the part of the pancreas with the tumour in it will only remove most, but not all, of the tumour. There is no advantage to you from a partial removal of the tumour. Continuing with the operation to remove the tumour, but leaving some behind, will delay or prevent more appropriate treatment (e.g. Chemotherapy).
The aim of the surgery is to allow you to recover as quickly as possible (so more appropriate treatment may be started), and at the same time make sure the liver and stomach continue to work properly during that treatment. The surgeon will join the bile duct directly to part of the small bowel called the jejunum. This allows the bile to flow from the liver into the small bowel and in time the jaundice should fade. At the same time your surgeon will connect a piece of small bowel to the stomach, to bypass the duodenum. This will allow your stomach to empty properly and should prevent blockage of the duodenum at a later stage.
You may be cared for in a high dependency unit (HDU) before going back to the ward. You may be able to start drinking fluids in the evening after your operation and gradually start to eat foods. You will be able to go home once your eating and drinking has improved and your jaundice is getting better.