
1	The Pancreas
2	Pancreatic Cancer
3	Causes of PC
4	Heredity
5	Risk Factors
6	Diagnosis
7	Metastasis
8	Staging
9	Questions to ask
10	Surgical Treatment
11	Medical Treatment
12	Vaccine
13	Symptoms & Side Effects
14	Screening
15	Pain Management
16	Diet & Exercise
17	Final Stages & Hospice

Palliative Double By-pass (Roux-en-Y Procedure)

This procedure is for patients with tumors in the head of the pancreas which have been deemed inoperable because of metastases, vessel involvement, etc. As seen in Fig. 1 below, in these patients, the flow of bile (green) , food (red) and pancreatic fluid (yellow) are disrupted. In a normal pancreatic head, the bile duct and pancreatic duct join before emptying into the duodenum. As a tumor grows in the head of the pancreas, the common bile duct can become blocked, resulting in jaundice. The tumor can also bulge out against the duodenum and block the passage of food, shown by the pink arrow.

Essentially, the goal of the Double By-pass procedure is to re-route the flow of stomach contents and bile around the area where the tumor is blocking the normal flow ot the gastrointestinal system. This should alleviate jaundice, nausea and vomiting caused by the blockage.

Figure 2 illustrates how the anatomy is reconfigured during the double bypass procedure. On the left is the normal anatomy. First, the gallbladder is removed. The jejunum is cut and one of the ends is moved up and attached to the hepatic duct. Bile from the liver now flows through the hepatic duct and into the jejunum, bypassing the blocked bile duct and duodenum altogether.

The continuity of the gastrointestinal tract is maintained by joining a loop of the jejunum to the lower portion of the stomach and reattaching the cut end of the jejunum to another another section further down. This creates an open passageway for food to flow from the stomach to the small intestine by avoiding the blocked duodenum.

Often a tumor in this portion of the pancreas will grow large enough to press on nerves running along the spine, causing intense pain. A celiac nerve block will alleviate such pain for several months. This is accomplished by injecting alcohol into the affected nerves to numb the sensation of pain. A celiac nerve block can be performed during a surgical procedure or as a separate procedure.



We subscribe to the HONcode principles. Verify here.	This site is supported by generous educational grants from the Vesalius Trust
Disclaimer: No two patients with pancreas cancer are identical. The appropriate treatment of individual patients with pancreatic cancer varies greatly depending on the patient's medical and surgical history. The information expressed in this Web page is not medical advice. It is meant only to educate health care professionals and patients about the current status of treatment and research in pancreas cancer at Hopkins. Before making any medical decisions, patients with pancreatic cancer are advised to consult with their personal physicians.