Surgery to remove distal bile duct cancer

In this operation, the surgeon removes:

• the head of the pancreas
• most of the first part of the small bowel (duodenum)
• the common bile duct
• the gall bladder
• the surrounding lymph nodes.

This operation is also called a modified Whipple’s operation.

If you have had part of your pancreas removed, your body may struggle to control its blood sugar level. This is because the remaining pancreas may not be making enough insulin. You may need to have insulin injections. This is usually only until the remaining pancreas recovers and starts making insulin again.

You may need to replace the digestive juices (enzymes) that the pancreas normally makes. This will depend on the type of operation you have had and your ongoing symptoms.

Digestive enzymes help your body break down and absorb fats and protein. If you do not have enough of them, you may have diarrhoea. Your stools (poo) may float, look pale and smell bad. You will also find it difficult to put on weight because you cannot absorb nutrients from your food.

Pancreatic enzyme replacement therapy drugs

You can replace the digestive enzymes by swallowing capsules. You usually take these each time you eat or have a milky drink. Your surgeon, nurse or a dietitian will give you more information about how to take the capsules. You will need to take the capsules for the rest of your life.

These are some commonly used, pancreatic enzyme replacement therapy drugs:

• Creon^®
• Nutrizym^®
• Pancrease^®
• Pancrax^®.

Most replacement enzymes are made from pork. It is also possible to get enzymes made from beef. Vegetarian based enzymes are not available.

The most commonly used supplement is a tablet called Creon^®, which is a pork-based enzyme replacement. There is no alternative that is not pork-based.

Creon^® has been approved for Jewish patients to use by the Chief Rabbi. Previous rulings by Islamic scholars suggest that Muslim patients may use pork-based medicines if there is no alternative. If you are worried about this, speak to your religious leader.