Laparoscopic Distal Pancreatectomy with or without Splenectomy
Date issued: June 2021
Review date: June 2023
Ref: A-205/surgery/FH/Laparoscopic distal pancreatectomy with or without splenectomy v4
PDF: Daily Diary Laparoscopic Distal Pancreatectomy +- splenectomy final June 2021 v4.pdf [pdf] 745KB
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
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
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walk about
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breathe deeply
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eat, drink and sleep well
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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, your pain will be controlled by Patient Controlled Analgesia (PCA). You will also be given regular paracetamol through a drip. Once the PCA is stopped, your pain will be controlled by medicine in either 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.
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In bed keep the backrest raised at a slight angle
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Every hour you are awake do some gentle breathing and leg exercises as follows:
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Cough 2 to 3 times
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Take 2 to 3 slow deep breaths to help keep your lungs clear
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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
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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
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The nurses will assist you to gradually start walking. Build up the distance and time spent walking each day
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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.
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.
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
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A member of the surgical team will see you at least once a day
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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
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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)
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The next pages outline the routine for each day and include things that you should do to improve your post-surgery recovery.
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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 a PCA in place and will be given paracetamol through a drip.
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 PCA will be removed and your pain will be controlled by medicine in liquid or tablet form
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:
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eating and drinking well
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sitting in a chair for most of the day
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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
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Your blood pressure, temperature, pulse and breathing are all stable
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All test results are appropriate
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Your wounds are healing well
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Your pain is well managed
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You are able to walk
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You have someone to support you at home
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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 432071.
If you have any concerns or problems, please ring:
Stonehouse Ward 01752 431488
Wolf Ward 01752 439677
Claire Goulding/ Liz Whitby 01752 431527
(Cancer Nurse Specialists)
Derriford Hospital Switchboard 01752 202082
