Survivorship: Health Concerns After Whipple

A Whipple procedure is a surgery that removes part of the pancreas, small bowel, gall bladder, bile duct, and stomach along with surrounding tissues. It is used to treat pancreatic cancer and is also called pancreaticoduodenectomy. If the tumor is in the “tail” of the pancreas, a surgery called distal pancreatectomy may be done. This removes only part of the pancreas and, in many cases, the spleen. Be sure you talk with your surgeon to know exactly what was removed during your surgery.

Enzymes & Insulin

The pancreas has two main jobs: making enzymes to aid in the digestion of food, and making insulin. Both can be affected even if only part of the pancreas is removed.

• If you are not making enough enzymes for digestion, you can have bloating, gas, fatty diarrhea that floats in the toilet and is pale in color (steatorrhea), or weight loss. You can take supplemental pancreatic enzymes in pill form to reduce these side effects.
• In some cases after surgery, the pancreas does not make enough insulin. Because of this, you may become diabetic and may need insulin injections. This is usually found within a few days after surgery.

Gastrointestinal (GI) Side Effects

GI complications that can occur include:

• Dumping syndrome – This is nausea and abdominal (belly) cramping followed by diarrhea that occurs soon after eating.
• Slow emptying of the stomach, which can lead to feeling full after only a small amount of food. This can also cause bloating, heartburn, nausea, and vomiting.

To manage these problems:

• Eat small, frequent meals instead of 3 larger meals a day.
• Avoid high-fat and high-fiber foods.
• It is very important to get enough calories to maintain your weight. Working with a dietitian can be very helpful to manage problems and maintain good nutrition.
• Talk to your healthcare provider if you are not able to maintain your weight.

Diarrhea

Diarrhea makes it hard for your body to absorb fat-soluble vitamins such as vitamin D and magnesium. These vitamins are important to the health of your bones and not having enough of them can lead to osteoporosis. Your provider may monitor these levels with blood tests. You may need to take supplements (pills) of these vitamins.

Ulcer

In rare cases, an ulcer can develop where the bowel is reconnected. This can be a serious complication. You may be taking a proton pump inhibitor medication (such as omeprazole, lansoprazole, pantoprazole, esomeprazole) to prevent this. If you develop abdominal pain, call your provider.

Other Possible Side Effects

Abdominal (belly) surgeries can increase your risk for bowel obstruction (due to scar tissue), hernia (due to cutting the abdominal muscle), and changes in bowel movements. Radiation therapy that includes the abdomen and pelvis can increase the risk of these issues. If you develop constipation with abdominal pain, nausea and vomiting, or notice a bulging area in your abdomen, contact your care team.

If you had your spleen removed during your cancer surgery (called splenectomy), be sure you learn about important healthcare issues related to this.