From the Guidelines
Eating after a distal pancreatectomy is difficult primarily because this surgery removes part of the pancreas, which plays a crucial role in digestion, leading to potential malabsorption and digestive difficulties, as supported by the ESPEN guidelines on clinical nutrition in surgery 1. The pancreas produces digestive enzymes that break down proteins, fats, and carbohydrates, and when part of it is removed, there may be insufficient enzyme production. Patients often experience symptoms like bloating, gas, diarrhea, and abdominal discomfort after eating. To manage these difficulties, the following strategies can be employed:
- Pancreatic enzyme replacement therapy (PERT) is typically prescribed, with medications like Creon or Pancreaze taken with meals, as recommended by the ESPEN guidelines 1.
- The dosage varies based on the extent of pancreatic tissue removed and individual needs, but generally starts at 25,000-40,000 units of lipase per meal, with 10,000-25,000 units for snacks.
- Patients should also adopt dietary modifications including:
- Smaller, more frequent meals
- Limiting fatty foods
- Ensuring adequate hydration Recovery of digestive function can take several weeks to months as the body adjusts to the anatomical changes. The remaining pancreatic tissue may compensate somewhat over time, but many patients require ongoing enzyme supplementation to maintain proper digestion and nutrition, highlighting the importance of nutritional assessment and therapy in the perioperative period 1. Additionally, the ESPEN guidelines emphasize the importance of assessing nutritional status before and after major surgery, and initiating nutritional therapy in patients with malnutrition or at nutritional risk 1. Overall, a comprehensive approach to managing digestive difficulties after distal pancreatectomy involves a combination of enzyme replacement therapy, dietary modifications, and careful monitoring of nutritional status.
From the Research
Causes of Difficulty Eating after Distal Pancreatectomy
- The removal of the distal portion of the pancreas can lead to a loss of exocrine pancreatic function, resulting in malabsorption and maldigestion 2.
- Postoperative hyperglycemia and the location of the remnant pancreatic margin are independent risk factors for poor oral intake after distal pancreatectomy 3.
- Pancreatic exocrine insufficiency (PEI) and endocrine insufficiency can cause significant nutritional impairments, including weight loss and steatorrhea, and diabetes mellitus, respectively 4.
- Delayed gastric emptying, fat malabsorption, and hyperglycemia are common complications after pancreatic surgery, which can further compromise nutrition status 5.
Nutritional Consequences
- Malnutrition is a common consequence of distal pancreatectomy, with patients often experiencing weight loss and decreased serum albumin levels 2, 4.
- The use of pancreatic enzyme replacement therapy, such as pancrelipase, can help improve nutritional status and reduce malabsorption 2.
- Enteral nutrition is generally preferred over parenteral nutrition in patients after pancreatic surgery, as it can help prevent or reduce cachexia and improve outcomes 6, 4.
Risk Factors
- Preoperative nutritional status, sarcopenia, BMI, and serum albumin are prognostic factors for outcomes after total pancreatectomy 6.
- Postoperative glucose levels should be strictly regulated to prevent hyperglycemia and poor oral intake after distal pancreatectomy 3.
- Patients with a history of malnutrition or significant weight loss prior to surgery may be at higher risk for poor outcomes and may benefit from aggressive nutrition supplementation 4.