Nutritional sequelae of postsurgical total exocrine pancreatic insufficiency

Digestive function and nutritional status were studied in 24 patients who underwent pancreatoduodenectomy with suppression of exocrine pancreatic function by Neoprene injection. The ability of enzyme replacement (pancrelipase enteric-coated microspheres) in correcting steaorrhoea was assessed in association with different dietary fat intakes (isocaloric diets of 2,400 Kcal/day). In the early postoperative period, faecal fat excretion was on average 14.2±6.6g/day in 14 patients who received a 70 g/day fat diet, while it was 26.9±13.7 g/day in 10 patients treated with a fat-load diet (100 g/day) (p < 0.01). In all patients, the mean values of nutritional indices were on average at the lower limits of normal, and body weight was 89.1% of usual body weight (UBW). Patients were discharged on a low-fat diet (50 g/day). Six months after surgery, the average body weight rose to 93.8% of UBW (p < 0.01) and eight patients reached their UBW. All nutritional indicators showed a significant increase. In 10 patients faecal fat excretion was controlled while continuing on low-fat diet: steatorrhoea further decreased to 8.3±3.9 g/day (p < 0.01 vs 70 g diet) and 5 patients were within the normal range (< 7 g/day). The coefficient of fat absorpotion was 73.1%, 79.9% and 83.4% with a 100, 70 and 50 g/day dietary fat intake, respectively (r=-.372, p < 0.05). This indicates that a larger proportion of fat is absorbed when a smaller intake in given. In conclusion, a low-fat diet combined with enzyme replacement allowed the correction of steatorrhoea and the return to a good nutritional status.