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Date issued: June 2023

Review date: June 2025

Ref: A-205/surgery/FH/Laparoscopic distal pancreatectomy with or without splenectomy v5

PDF:   Daily Diary Laparoscopic Distal Pancreatectomy +- splenectomy final June 2023 v5.pdf[pdf] 335KB

About your Programme/Diary

This leaflet is for patients having the tail of the pancreas and possibly the spleen removed.  This operation is performed for benign (non-cancerous) and malignant (cancerous) disease.

This programme/diary is intended to help prepare and support you and your family/carers for 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 Admissions Ward 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 will be taken to a 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.

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 allows the area of the operation to recover.

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

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 may 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 a member of the 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 day after your operation, you can drink normally and on the second 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.

CREON

As you are having part of your pancreas removed your body may need help to digest food normally because you cannot make enough digestive enzymes.  To replace these enzymes, you may need to take a medicine called CREON with everything you eat - snacks and meals.  The team will give you more information about CREON and how to use it if this is appropriate.

Splenectomy: Removal of the spleen

The spleen is part of the immune system. If you have your spleen removed during surgery, you will need to take low dose antibiotics for life.  You should also have had some vaccinations before surgery to boost your immune system.  If you didn’t have the vaccinations before surgery the team will advise your GP to do them after you are discharged from hospital. Please visit the following website for further information on life without a spleen. (www.nhs.uk/conditions/spleen-problems-and-spleen-removal/ ).

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 the Pancreatic 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 (see page 4 for an explanation of words)

• 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 (Day 0)

Monitoring:

Your blood pressure, temperature, pulse and breathing will be checked at least hourly.

You will have blood tests.

Pain Control:

You will have an Intrapleural catheter/ PCA/ Rectus sheath catheter in place and will be given paracetamol through a drip until Day 2.

DVT Prophylaxis:

You’ll be wearing TED stocking and have a blood thinning. injection (in the early evening) every day while in hospital and for 28 days once home.

Drips, Drains and Tubes:

Oxygen will be given through a mask.

A urinary catheter will be in place.

An abdominal drain will be in place.

A naso-gastric (NG) tube will be in place.

You’ll have fluids through a drip.

Drinking:

You can have sips of water as soon as you want.

Exercise:

Keep your backrest raised at a slight angle when in bed.

Do your deep breathing and gentle leg exercises in bed (see page 5)

First day after operation (Day 1)

Monitoring:

Your blood pressure, temperature, pulse and breathing will be checked every 2-4 hours.

You will have blood tests.

Pain Control:

Same as Day 0.

Drips, Drains and Tubes:

Your urinary catheter will be removed.

Drinking:

You can start drinking normally.

Exercise:

Keep your backrest raised at a slight angle when in bed.

Do your deep breathing and gentle leg exercises in bed.

You will be assisted to sit in a chair in the morning and afternoon and to start walking 2 to 4 times.

Second day after operation (Day 2)

Monitoring:

Your blood pressure, temperature, pulse and breathing will be checked every 4-6 hours until you leave hospital.

Drips, Drains and Tubes:

Your IV drip and Naso-Gastric tube will be removed.

Your abdominal drain will be removed (if there are no concerns).

Pain Control:

Your Intrapleural catheter/ PCA/ Rectus sheath catheter will be removed.

You will be given medicine as liquid or tablets to manage your pain.

Wound Care:

If your wound is dry, the wound dressing will be removed.

Eating and Drinking:

You can now start eating.  You may prefer to eat little and often.

Exercise:

You should aim to walk more often and further distances than yesterday.  Aim to sit out of bed for at least 8 hours.

Dressing:

You should try to wash yourself and dress in your normal day clothes.

Third day after operation to leaving hospital

(Day 3 onwards)

All your drips, drains and tubes should now be removed.

Your tablets / medicine should be controlling any pain.

You should continue to help your recovery and reduce the risk of developing a post operation complication by:

• eating and drinking well.

• sitting in a chair for most of the day.

• walking further and more often than you did the day before.

You should be able to wash and dress yourself as well as you could before your operation.

You will be discharged when

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

• All 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 nurse if you are going to be seen by a 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 up on your recovery.

Surgical Follow Up Appointment

Once discharged you will receive an outpatient appointment.  This appointment should be 4-6 weeks from the date you were discharged.  If you don’t receive an appointment, please ring the consultant secretary on 01752 432150.

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