Postoperative management of patients with total exocrine pancreatic insufficiency

Abstract

The occurrence of maldigestion and malnutrition was studied in 14 patients who had undergone pancreaticoduodenectomy and occlusion of the Wirsung duct with Neoprene. Before discharge patients were put on a 70 g/day dietary fat intake. Mean faecal fat excretion was 32.9 g/day without enzyme replacement and fell to 14.2 g/day with pancrelipase supplementation. At discharge all patients were underweight (88 per cent of the usual mean body-weight) and nine patients showed alteration in laboratory nutritional parameters. At the time of discharge a low-fat diet (50 g/day) was prescribed. Six months after surgery, mean faecal fat excretion decreased further to 8.3 g/day (P less than 0.01) and all patients but one gained weight, reaching 93 per cent of the usual mean body-weight with normalized nutritional parameters. Our data show that the combination of enzyme replacement therapy and low-fat diet allows good correction of steatorrhoea and a significant improvement in nutritional status.

Complications of Pancreatic Surgery and the Role of Perioperative Nutrition

“…The difference in tolerance of early enteral feeding in patients who underwent injection of Neoprene ® into the pancreatic stump [12], which completely abolish the exocrine pancreatic secretion [13, 14], and in patients who underwent pancreaticojejunal anastomosis were also studied. Forty-one of the 61 (67%) patients treated with Neoprene ® and 27 of the 39 (69%) patients with anastomosis were randomized to enteral nutrition.…”

Deficiencies of micronutrients, altered bowel function, and quality of life during late follow-up after pancreaticoduodenectomy for malignancy

“…Without enzyme supplements steatorrhoea may occur in up to a third of the patients who have undergone PD, and adequate treatment of these symptoms has the potential to make a significant impact on the quality of life [22]. Traditional management of steatorrhoea by reducing dietary fat and prescribing enzyme supplements is effective [18]. Since our earlier study, we have been careful to avoid advising a low-fat diet, suggesting instead a normal diet, with increased enzyme supplements and therapeutic acid suppression to control steatorrhoea.…”

“…It was surprising that only 4 patients had low selenium serum levels. Selenium deficiency may theoretically contribute to the aetiology of chronic pancreatitis (in its role as an anti-oxidant) and so should probably be avoided after PD, particularly where there is a risk of obstructive pancreatitis secondary to anastomotic stricture [8,18].…”

Pancreaticoduodenectomy for Peri-Ampullary Neoplasia Leads to Specific Micronutrient Deficiencies

“…Although vitamin E levels were also significantly lower amongst patients, they were generally within the normal range and it is possible that other anti-oxidant mechanisms may compensate. With the recognition that anti-oxidant deficiencies contribute to the pathophysiology of chronic pancreatitis, selenium and vitamin E deficiency should probably therefore be avoided in patients who are at risk of obstructive pancreatitis secondary to anastomotic stricture [13,14] .…”