Management of nutritional issues after major pancreatic resections

Pancreatic resection is associated with a number of long term gastrointestinal complications that can lead to malnutrition and a consequent reduction in the quality of life. These are predominantly the manifestation of exocrine and endocrine insufficiency, gastrointestinal dysmotility, biliary dysfunction and bacterial overgrowth. Such sequelae can lead to reduced oral intake, macro- and micronutrient malabsorption, and impaired glucose homeostasis, which adversely impact on the patient’s well-being. In order to minimise these complications after major pancreatic resection, it is imperative to identify these deficiencies and closely monitor the patient’s energy consumption, symptoms and nutritional status. The management needs to be coordinated using a multi-disciplinary approach and in each case treatment individualized and based on an understanding of the anatomical, physiological and nutritional sequelae caused by the loss of pancreatic parenchyma through surgical resection.