Enzyme Substitution After Subtotal Cranial Pancreatic Resection Without Pancreaticoenterostomy

  • Å. Andrén-Sandberg
  • Z. Zdanowsky
Conference paper


The nutritional and metabolic sequelae of complete pancreatic exocrine insufficiency in humans have proved difficult to assess for methodological reasons. However, few surgeons perform total pancreatectomy, mainly due to the bad long-term results and a considerable operative mortality and morbidity (Andrén-Sandberg and Ihse 1983; Gudjonssen 1987). When pancreatectomy is performed both endocrine insufficiency and maldigestion are unavoidable consequences (Kenneth et al. 1965; Miyata et al. 1980). These metabolic and nutritional complications probably account for a substantial proportion of both early and late morbidity — and in certain cases even mortality. However, since these conditions are concomitant, the relative importance of each is almost impossible to assess (Braasch et al. 1978; McConnell et al. 1980). Furthermore, our knowledge of the extent of maldigestion, malabsorption, and malnutrition in patients with pancreatic exocrine insufficiency is also scarce. Most published studies on pancreatic insufficiency are done in patients with chronic pancreatitis in whom some degree of pancreatic function still may be present (Lankisch et al. 1986, Malfertheiner et al. 1987). Besides, most of these patients have other sequelae of alcoholism, too.


Chronic Pancreatitis Pancreatic Enzyme Total Pancreatectomy Pancreatic Exocrine Insufficiency Enzyme Supplementation 
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  1. Andrén-Sandberg Å, Ihse I (1983) Factors influencing survival after total pancreatectomy in patients with pancreatic cancer. Ann Surg 198:605–610PubMedCrossRefGoogle Scholar
  2. Ahrén B, Andrén-Sandberg Å, Tranberg KG, Bengmark S (1989) Subtotal pancreatectomy for cancer: closure of the pancreatic remnant with staplers. HBP-Surgery 2:29–39Google Scholar
  3. Braasch JW, Vito L, Nugent FW (1978) Total pancreatectomy for end-stage chronic pancreatitis. Ann Surg 188:317–322PubMedCrossRefGoogle Scholar
  4. Braga M, Cristallo M, De Franchis R, Mangiagalli A, Agape D, Primignani M, Di Carlo V (1988) Correction of malnutrition and maldigestion with enzyme supplementation in patients with surgical suppression of exocrine pancreatic function. Surg Gynecol Obstet 167:485–492PubMedGoogle Scholar
  5. Braga M, Cristallo M, De Franchis R, Mangiagalli K, Zerbi A, Agape D, Primignani M, Di Carlo V (1989) Pancreatic enzyme replacement therapy in postpancreatec-tomy patients. Int J Pancreatol 5 [Suppl 1]:37–44PubMedGoogle Scholar
  6. DiMagno EP (1982) Controversies in the treatment of exocrine pancreatic insufficiency (editorial). Dig Dis Sci 27:481–484PubMedCrossRefGoogle Scholar
  7. Gudjonsson B (1987) Cancer of the pancreas. 50 years of surgery. Cancer 60:2284–2303PubMedCrossRefGoogle Scholar
  8. Halgreen H, Pedersen NT, Worning H (1986) Symptomatic effect of pancreatic enzyme therapy in patients with chronic pancreatitis. Scand J Gastroenterol 21:104–108PubMedCrossRefGoogle Scholar
  9. Kenneth W, Warren M, Pluloutzos J (1965) Life after total pancreatectomy for chronic pancreatitis. Ann Surg 164:830–834Google Scholar
  10. Lankisch PG, Lembcke B, Wemken G, Creutzfeldt W (1986) Functional reserve capacity of the exocrine pancreas. Digestion 35:175–181PubMedCrossRefGoogle Scholar
  11. Malfertheiner P, Büchler M, Stanescu A, Ditschuneit H (1987) Pancreatic morphology and function in relationship to pain in chronic pancreatitis. Int J Pancreatol 1:59–66Google Scholar
  12. McConnell DB, Sasaki TM, Garnjobst W, Vetto RM (1980) Experience with total pancreatectomy. Am J Surg 139:646–649PubMedCrossRefGoogle Scholar
  13. Miyata M, Hamaji M, Yamamoto T, Nakao K, Sakaguchi H, Sakomoto T (1980) An appraisal of radical pancreatoduodenectomy based on glucagon secretion. Ann Sury 191:282–286CrossRefGoogle Scholar
  14. Rämö OJ, Poulakkainen PA, Seppälä K, Schröder TM (1989) Self-administration of enzyme substitution in the treatment of exocrine pancreatic insufficiency. Scand J Gastroenterol 24:688–692PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1991

Authors and Affiliations

  • Å. Andrén-Sandberg
    • 1
  • Z. Zdanowsky
    • 1
  1. 1.Department of SurgeryUniversity Hospital, Lund UniversityLundSweden

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