Considerations after your surgery

Pre-operative care and anaesthesia:

Patients are usually admitted to hospital on the day of their operation (or occasionally the night before if additional care is required e.g. some diabetic patients). Most commonly you will be instructed to attend the hospital’s pre-admission area 1-2 hours before the procedure, where you will undergo the formal admission procedure and go through a preoperative checklist. The Anaesthetist and Surgeon will often attend to go through the procedures benefits and risks and answer any last-minute questions.

You may be given a “pre-med” of drugs which are designed to help you relax. When the theatres are ready you will be transferred to theatre reception. From there, you will then be taken usually on a trolley to the anaesthetic room or into theatre. When everyone is ready, and before you go to sleep, there will usually be a “surgical pause” where before commencing any aspect of the procedure, your identity, the indication, details of the proposed procedure and all equipment and personnel required to provide the safest possible environment for the operation will be formally confirmed on a Surgical Safety checklist.

The anaesthetic team will prepare you for the procedure, which will usually entail placing a cannula (drip) in your arm, giving you some oxygen through a mask, and often placing an epidural catheter into your back to help pain management after the procedure. An anaesthetic agent will then be injected into the cannula into your arm and the next thing you will know is waking up after everything is finished.

An operation to remove a pancreatic tumour will usually take a minimum of 4 hours but can take much longer (8-10 hours). The length of the procedure is less relevant than ensuring every care is taken to achieve a complete resection. Longer operations usually reflect complexity because of the proximity of the tumour relative to other intra-abdominal blood vessels and organs and what is required to achieve clearance. In addition to drip in your arm, before commencing the operation, further tubes will be placed in your bladder (urinary catheter) and stomach (nasogastric tube via the nose), and in one of your wrist arteries to measure your blood pressure.

After your operation, you will usually wake up in the theatre or recovery room near to the operating theatre, where a nurse will care for you. You will then be taken to the High Dependency Unit (HDU) or occasionally the Intensive Care Unit (ITU) for 2 to 3 days so you can be monitored closely.

From there you will be taken to the specialist surgical ward.  Patients usually stay in hospital for between 10 to 14 days.

Tubes and drains

When you wake up from your operation you will have some tubes and drains attached to you. These will have been placed while you were asleep under anaesthetic. The type and number you will have depends on what type of operation you had but will often include:

• An intravenous drip – IV Tubes will be in a vein in your arm and usually also one in your neck, to provide you with fluids, medicines or monitor your fluid balance.
• A drain is usually placed into the abdomen close to where the tumour was removed and alongside any anastomoses (surgical joins between two structures) to control any fluid that can build up in the post-operative period.
• The bladder catheter will remain to collect and measure your urine to ensure your kidneys are working well. This means you don’t have to worry about getting out of bed to go to the toilet.
• The epidural catheter (placed into your back at the time of the operation) will often be used to deliver pain relief immediately for a day or so following the operation.
• The use of nasogastric or feeding tubes vary from Unit to Unit. After an operation, some surgeons prefer to keep the NG tube in for a short period after the operation to ensure fluid isn’t building up in the stomach, which could result in vomiting. Others prefer early removal to assist breathing. A feeding tube either going through your nose or directly into your tummy is occasionally used but most patients will be recommencing oral intake within 48-72 hours.

Your tubes and drains will be removed as soon as your medical team feels they are no longer needed.

Managing Pain 

The amount of pain experienced differs between individuals. Your medical team will work with you to ensure pain is kept to a minimum and it is essential you tell the nurses if you are feeling pain or if that pain gets worse. 

Some of the ways pain can be managed in hospital are:

• Epidural Catheter system (injection into the back usually immediately following surgery.
• Painkilling injections (every 3 to 4 hours).
• Painkiller suppositories – inserted into the rectum (back passage).
• Patient-controlled analgesia (PCA) consists of a machine containing painkillers connected to a drip. You can receive a dose of painkillers by pressing a button when needed. The machine prevents too many doses being given.
• Painkiller tablets.

Your doctors will explain which type of painkiller they will be giving you and how often you will receive it.

Post operative mobilisation.  

Mobility after an operation is essential to prevent a number of complications. The protocols followed in units vary from an Enhanced Recovery programme, which involves early mobilisation, patient-directed oral intake, and removal of the tubes and cannulae at the earliest opportunity, to a more formalised post-operative protocol with short-term fasting before removal of the tubes and cannulae, introduction of fluids and diet. Whatever the local protocol working hard at mobilising with the nursing and physiotherapy teams, intermittent deep breathing and moving particularly your lower limbs will prevent chest infections and blood clots forming in the veins in your legs. A dietician will advise you on the best foods to try as you recover but in general “little and often” works best. If not already on them, you are likely to be prescribed pancreatic exocrine replacement therapy (PERT) and oral nutritional supplements (high calorie/protein drinks).

Getting your results: 

Many patients and relatives are desperately keen to know the pathology results after a pancreatic resection. However, until the patient has recovered from the operation, the major risks to the patient surround the potential for the development of complications and not from the cancer for which the operation was performed. The surgical team therefore have a focus on your recovery, and it is usual that results are not available/discussed for 7-10 days.