If you have a Whipple procedure, nutrition immediately becomes an issue. This serious surgery is done for cancer localized to the head of the pancreas and may be done to save your life or prolong it. The medical name for this procedure is radical pancreaticoduodenectomy. There is now a modified procedure that can be used in some cases to preserve the entire stomach and pylorus.
The Whipple Procedure
The Whipple procedure involves removing the head of the pancreas, half of the stomach, the pylorus and duodenum, the gallbladder and the lower end of the common bile duct as well as a portion of the jejunum. The pylorus is the part of the stomach that contains the valve into the small intestine. The duodenum is the first of the three sections of the small intestine. The jejunum is the second section of the small intestine. The remaining parts of the stomach, pancreas and common bile duct are sutured to different locations on the remaining section of the jejunum.
Mechanical Changes
After such an extensive procedure, there are mechanical problems with the digestive system that affect nutrition. The stomach is smaller. There is no pyloric valve to insure that the stomach contents do not reenter the stomach. The duodenum is gone and the jejunum is shorter, which leaves less tissue to absorb nutrients. The gallbladder is a pouch to store bile, and though not an essential organ, its function of ejecting extra bile into the duodenum when a high fat meal is consumed is lost. The liver will still produce bile, but it will flow into the jejunum as it is produced as opposed to being delivered to the duodenum as needed.
Chemical Changes
There are many digestive chemical changes with the Whipple procedure that have nutritional consequences. The reduction in the size of the stomach reduces the amount of gastric juices that are produced, including the intrinsic factor for utilizing vitamin B12. The absence of the duodenum decreases the amount of mucus that lubricates the intestinal walls. The loss of the gallbladder and the change in the bile delivery system may make digesting fat more difficult. The digestive enzymes from the pancreas and duodenum are decreased or lost, including the enzyme that triggers the need for bile. The remaining pancreatic tissue will continue to produce enzymes and hormones but in smaller amounts that may not be sufficient. Diabetes can result from insufficient insulin and is a known complication of this surgery, according to "Complications in Surgery".
Considerations
Most assimilation of digested food into your body occurs in the small intestine. The loss of a portion of small intestine means a loss of nutrients to your system. Due to the mechanical changes as well as the chemical changes, it may be difficult for you to eat and digest the meals that you need to maintain your weight and health.
Expert Insight
Living well after a Whipple procedure is possible with the help of professionals in the fields of medicine and nutrition. Every case is individual and must be treated as such. In general, as explained by the Pancreatic Action Network, you will not be able to eat as much at one time and should eat five or six small meals a day. You should avoid high fat and fried foods. Pancreatic enzymes are often needed and must be taken with each meal to improve nutritional absorption. You may need vitamins in larger amounts than you took prior to surgery. To avoid overdose or imbalance, carefully follow the advice of your professional team. Vitamin B12 can be administered by injection if needed. Insulin can be prescribed if the remaining pancreas does not function well. You may require a diet that is higher in calories and nutrients than your former diet but lower in refined sugars.
References
- "Handbook of Medical-Surgical Nursing" (4th Edition); Mills, Elizabeth Jacqueline; 2006
- "The Language of Medicine" 6th Edition; Davi-Ellen Chabner, BA, MAT; 2001
- "Complications in Surgery " (1st Edition); Editors: Mulholland, Michael W., Doherty, Gerard M.; 2006
- Pancreatic Cancer Action Network
- "Nutrition in Clinical Practice"; Understanding clinical issues in postoperative nutrition after pancreaticoduodenectomy; Zgodzinski, Witold. Dekoj, Thomas. Espat, N Joseph; December, 2005
