Endocrinological aspects of managing patients after total duodenopancreatectomy

Abstract

The presented review of literature reflects the endocrinological aspects of patient management after total duodenopancreatectomy without β-cell transplantation in the immediate and late postoperative period. Peculiarities of carbohydrate metabolism after total duodenopancreatectomy require other approaches and methods of correction. Mortality in specialized centers in the last decade is <3-5%. The largest number of life-threatening complications occurs in the early postoperative period and remains high (49% and higher) despite the observance of international treatment standards, starting from the intensive care unit. In the early postoperative period, imitation of insulin secretion from a healthy pancreas is of particular importance. The use of devices of the “closed loop” type after total pancreatectomy made it possible to identify the required dose of short-acting insulin (100-200 units per day intravenously) to maintain plasma glucose in the range 4.4-7.7 mmol/l, ensured patient safety, and reduced the number of surgical complications. Individually selected insulin therapy, enzyme replacement therapy and balanced nutrition in the long-term postoperative period provide patients who have undergone total duodenopancreatectomy an acceptable standard of living comparable to the quality of life of patients with type 1 and type 2 diabetes.