Survivorship: Health Concerns After Whipple

Author: OncoLink Team
Last Reviewed: September 18, 2019

A Whipple procedure is a surgery (also called pancreaticoduodenectomy) that removes part of the pancreas, small bowel, gall bladder, bile duct, and stomach along with surrounding tissues, and is used to treat pancreatic cancer.

Enzymes and Insulin

The pancreas has two key functions: providing enzymes to aid in the digestion of food, and the production of insulin. If you are not producing enough enzymes for digestion you can suffer from bloating, gas, fatty diarrhea that floats in the toilet and is pale in color (steatorrhea), or weight loss. Survivors often need to 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, survivors can become diabetic and may need insulin injections. This is usually discovered within a few days after surgery.

GI Side Effects

Other complications that can occur are dumping syndrome (nausea and abdominal cramping followed by diarrhea), delayed emptying of the stomach leading to a feeling of fullness after only a couple of bites, bloating, heartburn, abdominal pain, and nausea/vomiting. To manage these problems, it may be best to consume small, frequent meals and 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. Survivors should seek help from a dietitian and talk with their provider if they find they are not able to maintain weight.

In addition, abdominal surgeries can put survivors at risk for bowel obstructions (due to scarring), hernia (due to cutting the abdominal muscle) and changes in bowel patterns. Radiation therapy to the abdomen and pelvis can increase the risk of these complications.

References

Capurso, G., Traini, M., Piciucchi, M., Signoretti, M., & Arcidiacono, P. G. (2019). Exocrine pancreatic insufficiency: prevalence, diagnosis, and management. Clinical and experimental gastroenterology12, 129.

Gianotti, L., Besselink, M. G., Sandini, M., Hackert, T., Conlon, K., Gerritsen, A., ... & Marchegiani, G. (2018). Nutritional support and therapy in pancreatic surgery: A position paper of the International Study Group on Pancreatic Surgery (ISGPS). Surgery164(5), 1035-1048.

Goess, R., Ceyhan, G. O., & Friess, H. (2016). Pancreatic exocrine insufficiency after pancreatic surgery. Panminerva medica58(2), 151-159.

Romano, G., Agrusa, A., Galia, M., Di Buono, G., Chianetta, D., Sorce, V., ... & Gulotta, G. (2015). Whipple’s pancreaticoduodenectomy: Surgical technique and perioperative clinical outcomes in a single center. International Journal of Surgery21, S68-S71.

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