Postoperative Biological and Physiological Gastrointestinal Changes after Whipple Procedure

Abstract

In the last years there was an increased interest towards the pancreatic cancer, especially considering its growing incidence (rapidly becoming the fifth cause of death by cancer in the developed countries), lack of any sustainable markers and/or risk factors and the chilling fact that almost 95% of the patients with this disorder are presenting to the hospital in the advanced and unresectable stages. Even more, although known and developed for almost 70 years, the surgical approach for the pancreatic cancer is a subject of debate because its efficacy and postoperative biological changes. It is known that the most common surgery in chronic pancreatitis and pancreatic cancer is represented by the Whipple pancreatico duodenectomy. Still, after an extended resection and reconstruction of the upper gastrointestinal tract, it seems that the digestive physiology can be disrupted. In this way, in the present mini-review we will describe some postoperative gastrointestinal biological and physiological changes after Whipple procedure, by mainly focusing on the gastrointestinal motility, bone demineralization, dumping and re-resection, as well as on the affected pancreatic function, postoperative weight loss and remnant pancreatic fibrosis and how the management of this related pathological aspects can be applied in these cases.