Surgeries

PREPARATION & RECOVERY

 

PRE-ASSESSMENT

An appointment will be made for you to attend our pre assessment clinic before your surgery. A pre assessment nurse will ask you questions about your medical history, take a tracing of your heart (ECG), and record your blood pressure and pulse. You will probably also need to have a blood test. You may have an opportunity to meet the upper GI support sister who will be able to answer any questions you have regarding the surgery or your hospital admission.
Your pre assessment visit will include being assessed by an anaesthetist who will decide upon your fitness for surgery. He/she will also discuss the anaesthetic and methods of pain relief with you. This visit to hospital can take up most of the morning or afternoon, as there are various consultations/ investigations to organise so you may wish to bring a book or magazine for between appointments. Please bring a list of all your current medicines and tablets.

 

AFTER THE OPERATION

From the recovery suite in theatres, you will be transferred to the surgical high dependency unit (or to the intensive care unit if that is necessary). You will remain there for a few days to receive specialist care and monitoring from skilled critical care doctors and nurses. Your tummy may hurt so please ask the nursing staff for pain relief if you are unable to breathe deeply and cough easily. It is important that you can breathe properly in order to prevent developing a chest infection.
You will return to the upper GI ward when your surgeon and the ICU/HDU consultant are satisfied that you no longer need intensive nursing care. It is important that you try to get up and move about as soon as possible after the operation. This will not only help your chest but also help to prevent blood clots in your legs. To begin with, you will have many tubes attached to your body that you didn’t have before going to theatre. You may find these frightening and uncomfortable but as your condition improves they will decrease in number. It is normal to have some or all of these after this kind of surgery:
  • tubes resting on your nostrils or a plastic mask attached to a thick tube to give you oxygen
  • a tube in your nose to provide liquid feed down into your tummy while the joins heal
  • a tube in your nose to collect excess acid and bile from your stomach
  • a tube stuck to your neck with a clear plaster for drips, medication and liquid food
  • drips in your arms/hands to keep you hydrated
  • tubes called drains to collect excess fluid from the operation site
  • dressings over the wound site
  • a urinary catheter (tube into your bladder to collect urine).
Most of these tubes and drains are removed by the end of your first week in hospital, occasionally you will still have a tube coming out of your tummy when you first go home. If this is necessary then we will make sure that you understand why it is there and know how to look after it until we remove it in clinic. The length of stay in hospital after this surgery is quite variable, but the average is 10 to 14 days. If you are over 75 or have other health problems you may need to stay in longer, whilst some very fit patients may go home as early as one week after the operation if they recover quickly.
If you have complications after this surgery occasionally you need to stay in much longer. It is a good idea to start thinking about how you will manage at home after your surgery before you come into hospital. If you live alone or your partner is not able bodied then we may need to help you make plans for a short period of convalescence afterwards.
It is best to talk to your close family and friends as well the upper GI support sister and GP to see what options you have, either a relative staying with you or you staying with family or friends is often best if this is possible. If you think you are going to need us to help organise convalescence, then let us know as soon as possible so we can help make arrangements in advance. Once we decide that you are fit enough to be discharged you will usually recover faster if you are able to convalesce outside of hospital.

 

FURTHER TREATMENTS

If the sample of pancreas removed during the operation turns out to include cancer cells, then you may be referred to see an oncologist (a doctor who specialises in treating cancer with chemotherapy). Chemotherapy may be given to you as an injection, drip, or tablets, but you will have the chance to discuss this in more detail with the specialist doctor and nurses if applicable. Occasionally, chemotherapy is prescribed before starting surgery. It is very important that you understand your choices and you have the treatment, which is most effective for you and your circumstances.

 

DIABETES

The pancreas produces insulin that is required for control of blood sugar. There is a risk of developing diabetes after this operation. In most cases, patients who are not diabetic before surgery are unlikely to develop diabetes afterwards. If you are diabetic before your operation, you may need additional medication or insulin after surgery. The cancer may sometimes cause diabetes and it may be easier to treat after the operation. The normal range for your blood sugar level is between 4- 7mmol before you eat a meal. Before you are discharged from the hospital you maybe taught how to use a blood glucose meter and be advised to check your sugar levels at home. If your sugar level is outside the normal range or if you are concerned you will need to seek help/advice from your surgery.

 

RETURN TO NORMAL ACTIVITIES

When you return home, you will find movement and activity difficult for the first few weeks, and you will probably need help around the house, making meals etc. You may also feel low in mood, but this should resolve shortly. It is important to try and achieve a healthy balance between activity and rest. You may think about returning to normal activities after three to six months. This will vary on an individual basis.

 

DIETARY CHANGES

The pancreas produces enzymes, which are needed to digest (break down) food. The surgery you are having will affect the production of these enzymes. This may lead to poor digestion, and absorption of food. If this occurs it can result in loose stools that are greasy, pale and with a tendency to float. You will be prescribed Pancreatic enzyme capsules to help digest your food properly, and keep your bowels working normally. Your doctor, pharmacist, dietitian and specialist nurse will advise you on taking these while you are in hospital.
There will be no restriction on your diet after the operation, unless you have developed diabetes. Your stomach will be slightly smaller after the surgery, so you may find that eating little and often helps to prevent symptoms of bloating and feeling full. This is normal in the first few weeks and should improve with time. Weight loss is common after surgery but it is important to try and avoid this. Focus on eating high calorie, high protein meals, snacks and drinks following your operation. The dietitian will give you further advice and information.

 

DRIVING

This will depend on the type of operation you have had. You should ask the medical staff for specific advice. However, generally you should not resume driving until your level of concentration, strength and mobility have improved enough for you to drive safely. It is important to ensure you are able to perform an emergency stop and this should be practised on a quiet road when you feel ready. If you cannot do an emergency stop confidently then you cannot drive a car. It is always advisable to check with your insurance company prior to starting driving again.

 

RETURN TO WORK

The time at which you are able to return to work depends on the nature of your surgery and type of work you do. Your surgical team of doctors and nurses will be able to advise you, although this may need reassessing depending on how you recover at home. Every person’s rate of recovery is different but as a rough guide someone doing a heavy manual job will probably need at least six months before being able to work normally again, although if you can do light duties you may be able to go back to work a little sooner. Someone doing a desk job should expect to take a minimum of three months off. If you have chemotherapy after your surgery this will often mean that you find it difficult to get back to work full time until after this has finished.
You must remember that you will get tired very quickly in the first few months after surgery and your concentration and decision making will be poor to start with as well, so it is best not to rush back to full-time work too soon as it may slow down your recovery and you may make mistakes. It is sensible to see if you can go back to work part time or on light duties for a few weeks when you first go back to work.

STAGING LAPAROSCOPY

Laparoscopy is keyhole surgery, it uses small cuts in the abdomen to put a telescope camera and thin instruments into the abdominal cavity. A staging laparoscopy examines the surfaces of the abdominal cavity, especially the liver and the peritoneum, for metastatic disease. While a high resolution CT scan gives an amazingly detailed picture of the abdomen, many patients will have metastatic or locally advanced disease found at surgery.
The purpose of a staging laparoscopy is to avoid a laparotomy (full length abdominal incision) in someone with inoperable disease. The recovery from this laparoscopy is much easier and faster than from laparotomy.

WHIPPLE PROCEDURE

This procedure is named after the American surgeon, Dr Allen Whipple, who developed the surgery during the 1930s. It is also occasionally referred to as a pancreatoduodenectomy in reference to the organs that are removed.
During the Whipple’s operation, the head of pancreas, a portion of the bile duct, the gallbladder and the duodenum are removed, usually with part of the stomach. After removal of these structures, the remaining pancreas, bile duct and stomach are rejoined to the intestine. This allows pancreatic juice, bile and food to flow back into the gut, so that digestion can proceed normally. The operation normally lasts four to eight hours.

whipple

The Whipple’s operation is usually performed for cancers in the head of the pancreas but is also used to treat other tumours and benign lumps in the pancreas, as well as cancers of the bile duct, duodenum or ampulla. Non-cancerous (benign) disorders such as chronic pancreatitis can be treated with Whipple’s surgery.
The aim of surgery is to remove all of the visible tumour. This means that you should live longer, with a better quality of life than you would without the operation. Without surgery, the average survival of patients with pancreatic cancer is less than one year, with very few people surviving more than two years. Your survival length should be longer if you are having the Whipple’s operation for a non-cancerous condition.
With other types of tumours, the results are often better. Although you will need time to recover from the operation, almost all patients who have this surgery get back to living their normal life. You should be able to eat and drink normally (although you will be given enzyme supplements to help your digestion) and get back to all your usual activities.

 

DISTAL PANCREATECTOMY

This operation is done under general anaesthesia. When you are asleep, the anaesthetist will insert an ET (endotracheal) tube into your airway via the mouth and connect it to a ventilator machine. Often, you will have a NG (nasogastric) tube passed from your nose into the stomach to deflate the stomach and prevent nausea and vomiting.
distpanc

 

OPEN PROCEDURE

This is the most common way to perform this operation. The operation usually takes 3-4 hours.
The incision used for this operation is either a horizontal one across the upper abdomen or a vertical one in the middle of the upper abdomen depending on your body shape. The pancreas and other abdominal contents are inspected to check for disease that was too small to be picked up by CT scan. The operation may need to be modified accordingly.
The pancreas body and tail together with spleen are freed from their usual attachments and the vessels are tied and the pancreas is divided with a stapler and the stapled end is reinforced with a biomesh. One or two soft drains are placed at the operation site and their ends are brought out of the abdomen and connected to small bottles.

 

LAPAROSCOPIC PROCEDURE (KEY HOLE)

In selected conditions the operation can be performed by laparoscopy (key-hole) surgery. This is performed through five small cuts to inflate the abdomen with gas and inserted a laparoscope which is a long telescope 10 mm wide with a camera attached to the end of it. Special long narrow instruments are used to perform the dissection and divide the pancreas with stapler. At the end of the operation, one of the cuts is enlarged to remove the resected part inside a special bag. Laparoscopic distal pancreatectomy is not suitable if cancer is confirmed or suspected or if the disease process is advanced.

MINIMALLY INVASIVE LAPAROSCOPIC

Laparoscopy is keyhole surgery. Instead of making a large incision, it uses small cuts in the abdomen to put a telescope camera and thin instruments into the abdominal cavity. The camera gives an excellent view and the surgery is conducted on a video monitor. The recovery from a laparoscopy is much easier and faster than from traditional open-incision surgery.

 

laparoscopy

ROBOTIC SURGERY

One step more advanced than laparoscopic keyhole surgery is robotic surgery. It also uses small cuts in the abdomen to put a telescope camera and thin instruments into the abdominal cavity, however this time the instruments are much thinner and smaller as they are held by robot arms. The robot arms have more degrees of freedom of movement than a human hand and can reach places that a human surgeon cannot. And the robots usually have 4 arms! Once again, this is a great step forward in reducing damage to internal organs caused by surgical access.

 

davinci