What should I eat the day before a pancreaticoduodenectomy?

What to Eat the Day Before a Whipple Procedure

You should eat a normal diet the day before your Whipple procedure, stopping solid foods 6 hours before anesthesia and clear liquids 2 hours before anesthesia. 1

Preoperative Fasting Guidelines

The traditional practice of fasting from midnight is outdated and unnecessary. Modern evidence-based guidelines recommend:

• Stop solid foods 6 hours before anesthesia 1
• Continue clear liquids until 2 hours before anesthesia 1
• Clear fluids empty the stomach within 60-90 minutes and do not increase aspiration risk 1

Recommended Preoperative Carbohydrate Loading

You should drink a carbohydrate-rich beverage the night before and 2 hours before surgery (unless you have severe diabetes with gastroparesis). 1

Specifically:

• 800 ml of carbohydrate drink the night before surgery 1
• 400 ml of carbohydrate drink 2 hours before surgery 1

This approach reduces:

• Postoperative insulin resistance 1
• Hunger, thirst, and anxiety 1
• May preserve skeletal muscle mass 1
• May reduce length of hospital stay in major surgery 1

What Constitutes "Clear Fluids"

Clear fluids include water, coffee, tea, and fruit-based lemonade (which is a safe alternative with similar gastric emptying time). 1

Special Nutritional Considerations

If You Are Malnourished

If you have significant malnutrition or weight loss, you should receive preoperative oral supplements or enteral nutrition for optimization. 1 However, routine preoperative artificial nutrition is not warranted for well-nourished patients. 1

Immunonutrition Consideration

Consider taking immunonutrition supplements (arginine-supplemented formulas) for 5-7 days before surgery, as this may reduce infectious complications. 1 The evidence suggests this is particularly beneficial in undernourished patients undergoing major gastrointestinal surgery. 1

What NOT to Do

• Do not use mechanical bowel preparation - this has no proven benefit and should not be used 1
• Avoid carbohydrate drinks if you have severe diabetes with anticipated gastroparesis 1
• Do not fast from midnight - this outdated practice increases insulin resistance and discomfort 1

Critical Timing Summary

Day before surgery:

• Eat normally throughout the day
• Take 800 ml carbohydrate drink in the evening 1

Morning of surgery:

• Stop solid foods 6 hours before anesthesia 1
• Drink 400 ml carbohydrate beverage 2 hours before anesthesia 1
• Stop all clear liquids 2 hours before anesthesia 1

This evidence-based approach, part of Enhanced Recovery After Surgery (ERAS) protocols, has been shown to improve outcomes without increasing complications. 1