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Date issued: June 2023

Review date: June 2025

Ref: Ref: A-213/surgery/FH/Bile Duct Resection v5

PDF:   Bile duct resection Final June 2023 v5.pdf[pdf] 331KB

About your Programme/ Diary

This leaflet is for patients having an open extended or hemi hepatectomy and possibly bile duct removal.  These operations are performed for benign (non-cancerous) and malignant (cancerous) disease.

This diary has been designed to help prepare and support you and your family/carers during your stay in hospital.

It outlines what should happen on each day.  Sometimes there will be a specific reason why something isn’t done but the team should explain this to you.  If you have any concerns about what has or has not happened on any day, please let a member of the team know.

The diary advises on what you can do each day to help your recovery after surgery and get you home as soon as it is clinically safe. It is a good idea to start planning for when you go home before you come into hospital, so that your discharge is not unnecessarily delayed.

Day of Operation (Day 0)

Before coming to hospital

On the morning of surgery, you must drink water until-

07:00 am if you are coming into hospital at 07:00 am

or

11:00 am if you are coming into hospital at 11:00 am.

You may be given water to drink whilst you are waiting in the hospital depending on the time of your operation.

Coming into Hospital

Please go to the Surgical Admissions Unit as advised on your admission letter. You will be checked in by a nurse and seen by members of the surgical and anaesthetic team before you are taken to theatre for your operation.

After your operation

After your operation you might go to the Intensive Care ward for 12-24 hours before moving to the surgical ward. 

Drips, Drains and Tubes

After your operation you will have several drips, drains and tubes in place:

An intravenous (IV) drip is used to give you fluids until you are able to drink normally.

An abdominal drain is a tube inserted near your abdominal (tummy) wound to help drain off fluid and prevent swelling.

A naso-gastric (NG) tube  is a fine tube that passes down your nose into your stomach and allows any fluids to be removed so that you don’t feel sick. This helps the area of the operation to recover.  The nurses might spigot the NG tube which means that a bung is put in it.  It will be cleared every 4-6 hours to drain off any excess fluid that may still be in your stomach. 

A urinary catheter is a tube (catheter) put into the bladder to drain your urine into a collecting bag.

A Intrapleural catheter/ Pain Controlled Analgesia (PCA)/ Rectus sheath catheter are fine tubes that deliver pain medication.

Reducing the risk of developing deep vein thrombosis (blood clots) – DVT Prophylaxis

You will wear TED stockings which help to maintain circulation in the leg and reduce the risk of blood clots forming (DVT – deep vein thrombosis).  You will wear them for the whole of your hospital stay.  You will also be given a daily injection of a blood thinning medicine (Clexane) which you will need to carry on using for 28 days once discharged from hospital.

Pain Control

It is important that your pain is well controlled so that you can

• walk about

• breathe deeply

• eat, drink and sleep well

• recover more quickly

If at any time you feel your pain is not well controlled, it is important that you tell the nursing team. 

On the first few days after the operation, you will have your pain controlled by a Intrapleural catheter/ Pain Controlled Analgesia (PCA)/ Rectus sheath catheter, these are fine tubes that deliver pain medication. You will also be given regular paracetamol through a drip.  Once the Intrapleural catheter/ PCA/ Rectus sheath catheter is stopped, your pain will be controlled by medicine in liquid or tablet form.

Sickness

If you feel sick (nausea) let the doctors or nurses know, as there are medicines which can help.

Exercise

Moving around as soon as possible after your operation will reduce your risk of developing a chest infection and blood clots and will help you recover from your operation more quickly. 

• In bed keep the backrest raised at a slight angle

• Every hour you are awake do some gentle breathing and leg exercises as follows:

  • Cough 2 to 3 times.

  • Take 2 to 3 slow deep breaths to help keep your lungs clear.

  • Flex your ankles by pointing your toes up towards the ceiling and then down towards the floor, then circle your feet in one direction and then the other.

• The nurses will assist you to get out of bed and sit in a chair. Try to sit out in the chair for short periods in the morning and afternoon.  Each day you should aim to spend longer periods of time in a chair than the previous day.

• The nurses will assist you to gradually start walking.  Build up the distance and time spent walking each day.

• As well as building up your level of activity every day, you also need to have proper rest periods.

Eating and Drinking

You will be encouraged to start drinking sips of water as soon as you feel able after your operation. 

From the second day after your operation you can drink normally. On the third day after your operation you will be able to start eating. Initially you might prefer to eat little and often. 

You may find that your sense of taste is altered and your appetite is less than normal after your operation.  It can take several weeks for taste to return to normal. 

It is important to eat and drink as your body needs fuel to repair. 

Personal Care

The nursing team will help you to wash yourself until you can manage on your own. 

Try to wear your day clothes in hospital as this can help you stay more active and be positive about your recovery. 

Review

• A member of the surgical team will see you at least once a day.

• If you or your family/carers need additional support or would like to talk to your Biliary Cancer Nurse Specialist, or the surgeons please speak to a member of staff.

• If your family/ carers would like to talk to the surgeons, please let the nurses know.

Daily Care

• The next pages outline the routine for each day and include things that you should do to improve your post-surgery recovery.

• Sometimes there will be a specific reason why something isn’t done but the team should explain this to you.

 

Day of operation

See page 4  for an explanation of drips and drains	Day of operation Day 0		First day after operation Day 1		Second Day after operation                 Day 2
Monitoring (blood pressure, temperature, pulse, breathing)	Hourly  checks (or more if necessary) Heart monitor attached Oxygen given through a mask		2-4 hourly checks (min) Heart monitor removed		4 hourly checks  (min)
Pain Control	Intrapleural catheter/PCA /Rectus Sheath in place. IV paracetamol		Pain control continues as before plus tablets or medicine		Pain control continues as before
DVT Prophylaxis	TED stockings Clexane injection		TED stockings Clexane injection		TED stockings Clexane injection
Abdominal Drain	In place, review day 2				REMOVED,  if appropriate
Urinary Catheter	In  place, review day 3				REMOVED,  if appropriate
Central Line	In place, review day 1		REMOVED if appropriate
IV Fluids	In place, review day 2				If you are drinking well drip will be stopped
NG Tube	In place, review day 2				REMOVED, if appropriate
Exercise	In bed: keep the head of the bed raised do your leg exercises do your deep breathing exercises   You’ll be assisted to sit out in a chair for a short time		You’ll be assisted to: sit out in the chair for a brief time in the morning & afternoon  walk a short distance   Continue your leg and breathing exercises		Sit out in a chair in the morning & afternoon for a little longer than yesterday. You will be assisted to walk 2-4 times during the day   Continue your leg and breathing exercises
Eating and Drinking	You can have sips of water as soon as you want		You can continue with sips of water		You can drink normally
Wound Care			Surgical wounds checked and dressings changed if necessary		If wound dry,  dressing can be removed
Personal Care			You’ll be assisted to wash yourself		You’ll be assisted (if necessary) to wash
Investigations	Chest X-Ray in recovery Blood tests		Blood Tests
		Third Day after  operation Day 3		Fourth to Seventh Day after operation Days 4-7
Monitoring (blood pressure, temperature, pulse, breathing)		4 hourly checks (of		6 hourly checks
Pain Control		Intrapleural catheter/PCA/ Rectus Sheath catheter REMOVED Continue pain control tablets or medicine		Continue pain control tablets or medicine
DVT Prophylaxis		TED stockings Clexane injection		TED stockings Clexane injection
Abdominal Drain		In Abdominal Drain place, review day 2
Urinary Catheter		w day 3
Central Line
IV Fluids		In place, review day2
NG Tube		REMOVE,  if appropriate
Exercise		Sit out in a chair in the morning and afternoon for a little longer than yesterday   You should be able to walk without assistance.  Try to walk further than yesterday   Continue your leg and breathing exercises		Sit out in a chair in the morning and afternoon for a little longer than yesterday   Try to walk more often and further than yesterday   Continue your leg and breathing exercises
Eating and Drinking		You can now eat and drink normally.  You may prefer to eat little and often.		Eat and drink normally.  You may prefer to eat little and often.
Wound Care				Surgical wounds checked and dressings hanged if
Personal Care		Try to dress in your  day clothes		Dress in your  day clothes
Investigations		Blood tests (Day 5)		Blood Tests

Fifth to Seventh Day after Operation  (Days 5-7)

You will be discharged when

• Your blood pressure, temperature, pulse and breathing are all stable.

• Your test results are appropriate.

• Your wounds are healing well.

• Your pain is well managed.

• You are able to walk.

• You have someone to support you at home.

• None of the team have concerns about your fitness.

When you go home

Check with the team to see if you need to be seen by your practice or district nurse.

If you had this operation to treat cancer, the cancer nurse specialist will ring you, normally within 7 days of discharge, to check on your recovery.

Surgical Follow Up Appointment

Once discharged, you will receive an outpatient appointment.  This appointment will normally be 4-6 weeks after discharge.  If you don’t receive an appointment, please ring consultant secretary on 01752 43150.

If you have any concerns or problems, please ring:

Stonehouse Ward                                         01752 431488

Wolf Ward                                                     01752 439677

Cancer Nurse Specialists                              01752 431527

Derriford Hospital Switchboard:                     01752 202082