We’ll always give your patients the care and kindness they need to tackle chronic pancreatitis and gastroparesis. Complicated and often misunderstood diseases, we treat your patients with cutting-edge surgical alternatives to turn their lives around.
VANGUARD IS A RELIABLE RESOURCE FOR YOUR PATIENTS SUFFERING FROM DIGESTIVE DISEASES
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When should I refer patients for chronic pancreatitis?
As early as possible! Chronic pancreatitis is a toxic environment for the Islets of Langerhans. Patients will become diabetic over time (diabetes 3c: 50% at 10 years and 80% at 20 years) and this natural history is not altered by traditional resection or drainage approaches (Whipple, Puestow, etc.). More advanced disease is associated with greater risk of diabetes, with pancreatic calcifications and exocrine insufficiency as independent risk factors. Dr. Hughes has largely abandoned these traditional approaches for total pancreatectomy with islet auto transplantation (TP-IAT). The earlier we perform TP-IAT, the more pain-free life-years the patient has, the more islets we get and the more likely the patient is not diabetic long term.
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Are there any absolute contraindications for TP-IAT?
There are a few:
▪️ Any ongoing alcohol use for patients with alcoholic chronic pancreatitis. These patients need to be abstinent for 6 months and complete a chemical dependency evaluation before being considered for the procedure.
▪️ Cirrhosis, portal hypertension or portal vein thrombosis. Under these conditions, neither pancreatectomy nor islet auto transplant can be safely be performed. On the other hand, splenic vein thrombosis does not preclude TP-IAT. In fact, the gastric varices associated with splenic vein thrombosis should resolve after splenectomy done with TP-IAT.
▪️ Non-compliance with medical therapy or inability to comprehend diabetes management. These patients become newly diabetic with the pancreatectomy. The likelihood of coming off insulin can be impacted by medical non-compliance as hyperglycemia is toxic to the engrafting islets.
▪️ Pancreatic malignancy. Pancreatic cancer cannot reliably be removed from the islets that are infused into the liver. Therefore, pancreatic cancer is still best treated by segmental resection.
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Does islet auto transplant (IAT) treat diabetes?
It does not. It just preserves the islets that the patient still has. All patients are temporarily diabetic as we wait for the islets to engraft in the portal venous system. Our endocrinologists start weaning patients off insulin 3-6 months following the surgery.
We explain to patients that TP-IAT is only for those patients willing to trade pain for diabetes, with the hope that the diabetes is only temporary.
Islet allo-transplantation treats select type I diabetics by transplanting islets from a deceased donor into the diabetic patient. Islet allo-transplantation requires immunosuppression while islet auto-transplantation does not.
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How many patients become pain free following TP-IAT? How many patients come off narcotic pain medication?
We have abandoned traditional surgical approaches because pain control following TP-IAT is far superior and more durable. After TP-IAT, there is no pancreas to cause pain and nearly all patients are pain free long-term. We wean >90% of patients off narcotics by 6 weeks. The first week narcotic-free is often very challenging due to physical dependency. However, once the week is over patients feel better than they have in years.
“Dr. Hughes is taking excellent care of all our patients. He is very personable, spends great amount of time with patients to explain his treatment options. Our patients feel better after his interventions. Our office gets excellent feedback after office visits and surgeries and regarding future care of the patients. Our office is highly recommending Dr Hughes.” Dr. Anita Torok, Jackson Purchase Gastroenterology, Mayfield, KY.
“I’ve known Mike and his staff for years. They help me take care of some of my most difficult to treat patients. These are great people devoted to patient care. The level of communication that I receive regarding my patients is really unparalleled. Mike takes pride in his ability to offer surgical options in a truly underserved patient population (gastroparesis and chronic pancreatitis). He also does a wonderful job giving these patients options that aren’t offered elsewhere. He and his staff are a true asset to my patients and my practice.” Dr. Thomas Frazier, Director of Endoscopy and Nutrition, Gastroenterology, Three Rivers Medical Center, Louisa, KY.
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Does insurance cover TP-IAT?
Medicare is the only payer that does not cover islet auto transplantation. All payers cover total pancreatectomy. Our endocrinologists recommend still proceeding with TP (without IAT) for Medicare patients, as patients becomes diabetic over time without surgery and insulin pumps have become very sophisticated.
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Is your evaluation multi-disciplinary?
All of our patients are seen by our endocrinologists and diabetic nurse educators that specialize in islet auto transplantation. Patients are counseled what life is like with full islet function (insulin independence), partial islet function (C peptide is detectable but patient still requires one daily dose of long-acting insulin), and islet failure (diabetes 3c with no detectable C peptide and multiple doses of insulin per day). Mixed Meal Tolerance testing is performed to assess for impaired glucose tolerance. This helps counsel the patients on likelihood of long-term diabetes.
“Dr. Hughes and his team deliver the highest quality healthcare with exceptional results. He provides an invaluable service to my patients.” Dr. Jeffrey Riggs, Gastroenterology, Hopkinsville, KY.
“I have worked with Dr. Hughes for the past 10 years and found him to be a very caring and capable surgeon that is expert in the management of patients with gastroparesis and chronic pancreatitis.” Dr. Whitney Jones, Gastroenterology, Louisville, KY.
“I have referred many patients to Dr. Hughes and have been pleased with not only my patients’ outcomes and the care they received from him but also with the collaboration of care and communication he has with me.” Robin Sutcliffe, APRN, Baptist Health Medical Group, Gastroenterology, Lexington, KY.
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Why trust Dr. Hughes?
Dr. Hughes is a true surgical innovator when treating chronic pancreatitis. He trained as a transplant surgeon at the University of Minnesota under Dr. David Sutherland, the pioneer of TP-IAT who first performed the procedure in 1978. Dr. Sutherland trained Dr. Hughes in this procedure in addition to solid organ transplantation. Dr. Hughes came to Louisville, KY more than 10 years ago as Director of Pancreas Transplantation at the University of Louisville. He established the islet auto transplant program at Jewish Hospital with a nearly $1 million grant from the Jewish Heritage fund for Excellence. The TP-IAT program under his leadership was awarded the MediStar Healthcare Innovation Award in 2015. He then co-founded Koligo Therapeutics to expand TP-IAT to hospitals throughout the world. As Chief Medical Officer of Koligo Therapeutics, Dr. Hughes trains surgeons throughout the United States how to perform this procedure in addition to performing it himself in Louisville, KY at Vanguard Surgical. Having done more than 50 TP-IAT since starting the program in Louisville, he is one of the most experienced surgeons in the world performing this operation.
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How do I refer patients?
Have your staff call our office at 502-563-1261. We can fax you our referral form. With the referral, please send your clinic notes stating the patient has been diagnosed with chronic pancreatitis with any supporting labs, imaging and/or procedure notes. Dr. Hughes also asks that you share your mobile number so that he can contact you immediately following all surgeries. He will share his mobile number with you as well. We will also fax you clinic and operative reports. Thank you in advance for your referrals! We enjoy caring for chronic pancreatitis patients because we are able to improve their lives dramatically.
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How we communicate with you?
We are strong advocates for the safety and welfare of all of our patients. We will get them in quickly and answer all phone calls within 24 hours. Communication with you is also very important to us. We’ll text and call you after your patient’s operation and as a follow-up if there are any complications. We also do our best to fax op notes so that you are fully informed.
How to reach us:
Vanguard Surgical, LLC
Northwest Medical Office Building
2401 Terra Crossing Blvd, Suite 375
Louisville, KY 40245
Office: 502-563-1261
Fax: 949-655-8616
Email: info@vanguardsurgical.net