How TPIAT Works: Total Pancreatectomy with Islet Autotransplantation (TPIAT)

How is pancreatitis in kids treated?

Pediatric pancreatitis treatment often includes intravenous (IV) fluids, nutrition, pain relief and sometimes endoscopic interventions.

When medical and endoscopic treatments don’t work, your child’s care team may discuss surgical treatment – like total pancreatectomy with islet autotransplantation (TPIAT).

What is TPIAT?

Total pancreatectomy with islet autotransplantation, or TPIAT, is a complex surgical procedure. TPIAT is intended to relieve debilitating pain in children and adolescents with acute recurrent or chronic pancreatitis.

During the TPIAT operation, the diseased pancreas is removed to address the source of pain. The child’s own insulin-producing islets are then isolated from the pancreas and transplanted into the liver to preserve endogenous insulin production (the child’s ability to produce their own insulin) as much as possible.

How does TPIAT surgery work in children?

The TPIAT procedure happens in two stages.

Stage One: Total pancreatectomy and reconstruction

The surgeon removes the entire pancreas and the digestive tract is then reconstructed so food and digestive fluids can continue to move through the body.

The primary goal of removing the pancreas is to relieve severe abdominal pain. But without a pancreas, a patient would develop insulin-dependent diabetes.

Stage Two: Islet isolation and autotransplantation

A specialized laboratory team separates the islets from the removed pancreas. The surgeon then infuses those islets into the liver, where they may begin producing insulin and other hormones that regulate blood sugar.

The goal is for transplanted islets to begin producing insulin in the liver. This can reduce or eliminate the need for long-term insulin therapy.

What organs are removed during TPIAT surgery?

During TPIAT, the surgeon removes the entire pancreas, the gallbladder, and most of the duodenum, which is the first part of the small intestine. The spleen may be removed with the pancreas if the patient’s anatomy requires this. The appendix is also removed. The surgeon then reconstructs the digestive tract so food and digestive fluids can continue to move through the body.

Why are islets transplanted into the liver?

Islets contain beta cells that produce insulin and alpha cells that produce glucagon. These hormones help regulate blood sugar.

After the pancreas is removed, the islets are isolated and infused into the liver through its blood supply. The transplanted islets are expected to establish themselves in the liver and begin to produce insulin and glucagon again. Because the islets come from your child’s own pancreas, anti-rejection medicines are not needed.

What happens after TPIAT surgery?

After surgery, your child will recover first in the Pediatric Intensive Care Unit. The care team will closely monitor blood sugar, insulin needs, pain, fluids, nutrition, breathing, wound care and drainage. Feeding and drainage tubes placed during surgery will remain temporarily as recovery begins.

Once your child is stable, they will move to a general hospital unit. Before discharge, your family will receive education about insulin, blood sugar monitoring, pancreatic enzymes and other aspects of care at home.

Is TPIAT right for my child?

TPIAT is not for every child with acute recurrent or chronic pancreatitis.

Children with pancreatitis who have experienced abdominal pain for more than six months and have a significantly reduced quality of life are considered initial candidates for TPIAT. They are often unable to attend school or be active. They may have been hospitalized numerous times for pain.

At Nationwide Children’s, children receive a full medical and surgical evaluation before they are considered a TPIAT candidate.

Whether you're seeking a second opinion or looking to find out if TPIAT is right for your child, fill out the Speak With Our Team form to be contacted by our team.

Full Video Transcript: How TPIAT Works

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0:07

Children living with severe pain or poor quality of life from acute recurrent or chronic pancreatitis may benefit from a total pancreatectomy with islet autotransplantation, or TPIAT.

0:22

The primary goal of TPIAT is to relieve the pain and other symptoms of debilitating pancreatitis.

0:30

TPIAT has two stages. In the first stage, the pancreas, spleen, gallbladder and most of the duodenum are removed. And the surgeon will reconstruct the bile duct and stomach drainage and remove the appendix.

0:49

In the second stage, islets from your child's pancreas, which contain insulin-producing beta cells, will be transplanted into the liver. This may prevent insulin-dependent diabetes.

1:04

To begin, an incision will be made above the belly button. Part of the large intestine or colon will be moved out of the way and the pancreas, spleen and duodenum will be freed from surrounding tissue.

1:21

Then the surgeon will divide the bile duct, cystic duct and cystic artery and remove the gallbladder.

1:32

Next the right gastroepiploic artery will be divided.

1:39

And the first part of the small intestine or duodenum will be divided just beyond the stomach.

1:46

The gastroduodenal and splenic arteries will be identified and freed from surrounding tissue. The end of the duodenum will be freed from its supporting tissue. And the small intestine will be divided just beyond the duodenum.

2:06

In some cases, the inferior mesenteric vein may be divided and the pancreas will be freed from the portal vein underneath it.

2:18

Next the gastroduodenal artery and splenic artery will be divided, as well as the splenic vein.

2:31

At this point the pancreas will be removed along with the spleen and most of the duodenum.

2:41

The pancreas will be passed to the islet team to begin the process of islet isolation.

2:48

While the islets are isolated, the surgeon will reconnect the small intestine in two limbs or segments.

2:56

The first limb will be sutured to the bile duct.

3:03

Next this limb will be divided to create a second limb.

3:12

The end of the first limb will be sutured to the side of the second limb.

3:19

Then the top of the second limb will be sutured to the remaining duodenal end, and the appendix will be removed.

3:31

This completes the gastrointestinal reconstruction.

3:38

During stage two, the isolated islets will be infused slowly into the liver through its blood supply.

3:48

At the end of the procedure, feeding and drainage tubes will be placed and the incision will be closed.

3:56

After the procedure your child will be closely monitored in the Pediatric Intensive Care Unit.

4:05

For more information contact Nationwide Children's Hospital: NationwideChildrens.org/TPIAT