[Nutritional management after massive resection of the pancreas]

Eleven patients after total pancreatectomy and 68 patients after pancreatoduodenectomy were reviewed for evaluating the importance of nutritional management after massive resection of the pancreas. Nutritional supply by IVH resulted in maintaining and improving the hepatic function under obstructive jaundice in clinical and experimental studies. Administration of elemental diet after the operation shortened the period of IVH, and had a effect to spare the requirement of exogenous insulin. One of the most important problems after pancreatectomy with extensive dissection of the lymph nodes and the nerves around superior mesenteric artery was a malnutrition which appeared frequently after long term follow-up. The malnutrition should be treated by IVH as soon as possible for preventing further aggravation of digestive and absorptive function of the alimentary tract. Oral or nasogastric tube administration of elemental diet is useful for weaning the patient from IVH, and it serves to prevent subsequent development of malnutrition. In six totally pancreatectomized patients studied, postabsorptive plasma concentration of Arg., Lys., Thr., Ala., Gly., Ser. and Pro. were greatly elevated compared to normal value, however these abnormalities were normalized by 1 to 3 mg of glucagon administration. Glucagon administration resulted in no significant change in daily nitrogen balance.