Will difficulty eating persist after a distal pancreatectomy (surgical removal of the tail of the pancreas)?

From the Guidelines

Difficulty eating may persist after a distal pancreatectomy, but the severity and duration of these symptoms can vary greatly among patients, with some experiencing significant improvement over time 1.

Factors Influencing Outcome

The persistence of difficulty eating after a distal pancreatectomy can be influenced by several factors, including the extent of pancreatic resection, the presence of complications such as exocrine pancreatic insufficiency or delayed gastric emptying, and the effectiveness of postoperative management strategies.

• The study by Mathavan et al. 1 found that 2 patients had complete symptom resolution, 3 had occasional symptoms, 2 had frequent symptoms, and 2 patients had severe symptoms refractory to medical therapy after distal pancreatectomy.
• Another study by Rumilla et al. 1 reported that 8 patients had recurrent or ongoing mild symptoms after partial pancreatectomy.

Management Strategies

To manage difficulty eating after a distal pancreatectomy, several strategies can be employed, including:

• Pancreatic enzyme replacement therapy, such as Creon or Pancreaze, typically 25,000-40,000 units with meals, to improve digestion and nutrient absorption 1.
• Eating smaller, more frequent meals rather than three large ones to make digestion easier.
• Working with a dietitian to develop a personalized nutrition plan, which can help ensure adequate nutrient intake and minimize the risk of malnutrition 1.

Importance of Follow-Up

Regular follow-up with a healthcare provider is crucial to monitor the patient's nutritional status and adjust management strategies as needed. This can help identify potential complications early on and prevent long-term nutritional deficiencies.

• The ESPEN guideline recommends regular reassessment of nutritional status during the hospital stay and, if necessary, continuation of nutrition therapy, including qualified dietary counseling, after discharge 1.

From the Research

Difficulty Eating after Distal Pancreatectomy

• The surgical removal of the tail of the pancreas, known as distal pancreatectomy, can lead to pancreatic exocrine insufficiency (PEI) in some patients 2.
• PEI is characterized by the inadequate production of pancreatic enzymes, resulting in malabsorption of nutrients and difficulty eating.
• Studies have shown that 12-80% of patients undergoing distal pancreatectomy experience PEI post-operatively 2.
• The incidence of PEI can be influenced by factors such as the extent of the surgery, the health of the residual pancreas, and the type of reconstruction used 2.

Management of PEI after Distal Pancreatectomy

• Pancreatic enzyme replacement therapy (PERT) is a common treatment for PEI, and can help improve nutrient absorption and alleviate symptoms 3, 2, 4, 5.
• The dosage of PERT can vary depending on the individual patient's needs, but a starting dose of 50 to 75,000 units of lipase with meals and 25,000 to 50,000 units with snacks is often recommended 2.
• Patients who have undergone distal pancreatectomy should be individually assessed for PEI in the post-operative period, and those with extensive resection are more likely to experience insufficiency 2.
• In some cases, patients may require adjustment of their PERT dosage or referral to a specialist dietitian to manage their condition effectively 2, 6.