Open Extended and Hemi Hepatectomy
Date issued: July 2023
Review date: July 2025
Ref: A-208/surgery/FH/open extended and hemi hepatectomy v6
PDF: Open extended and hemi hepatectomy final June 2021 v5.pdf [pdf] 657KB
About your Programme/ Diary
This leaflet is for patients having an open extended or hemi hepatectomy, possibly with 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 admission 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 might be taken to Pencarrow or Penrose ward (Intensive Care). You will normally stay on this ward for at least 24 hours before going 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.
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. Only patients who have their bile duct removed will have an NG tube.
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
-
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 a member of the team 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.
-
-
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 eating and drinking as soon as you feel able after your operation. 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.
Eating and Drinking if you also had your bile duct removed -
You will be encouraged to have sips of water as soon as you feel able but will not be able to start eating until the second day after your operation.
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.
-
If you or your family/carers need additional support or would like to talk to your Liver Cancer Nurse Specialist or the surgeons please speak to a member of the team.
Daily Care
-
The next page outlines the routine for each day and includes 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.
See page 3 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 through a drip. |
Pain control continues as before plus tablets or medicine |
Pain control continues as before |
DVT Prophylaxis |
TED stockings on legs Clexane injection |
TED stockings on legs Clexane injection |
TED stockings on legs Clexane injection |
Abdominal Drain |
In place, review day 2 |
|
Remove, if appropriate |
Urinary Catheter |
In place, review day 2 |
|
Remove, if appropriate |
Central Line |
In place, review day 1 |
Remove, if appropriate |
|
IV Fluids |
In place, review day 2 |
|
Stop, if appropriate |
NG Tube (BD) * |
In place, review day 2 |
|
Remove, if appropriate |
Exercise
|
In bed:
You’ll be assisted to sit out in a chair for a short time (dependent on time get to ward). |
You’ll be assisted to:
Continue your leg and breathing exercises hourly |
Sit out in a chair in the morning and 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 |
Drinking and eating (BD)* see below |
You can start drinking and eating as soon as you feel able. Sips of water, NO food. |
Try to eat and drink normally. You might prefer to eat little and often. Sips of water, NO food. |
Try to eat and drink normally. You might prefer to eat little and often. Eat and drink freely |
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 |
If necessary, you’ll be assisted to wash |
Investigations |
Chest X-Ray |
Blood Tests |
|
Coloured text with (BD) only relates to patients who have also had a bile duct removal.
|
Third Day after operation Day 3 |
Fourth day after operation Day 4 |
Fifth – Seventh Day after operation Days 5-7 |
Monitoring (blood pressure, temperature, pulse, breathing) |
4 hourly checks (or more if necessary) Heart monitor attached Oxygen given through a mask |
6 hourly checks2-4 hourly checks in) Heart monitor removed
|
You will be discharged if you meet the criteria specified on the next page |
Pain Control
|
Intrapleural catheter/PCA/ Rectus Sheath catheter removed Continue pain control tablets or medicine |
Continue pain control tablets or medicine |
Continue pain control tablets or medicine continues as before |
DVT Prophylaxis |
TED stockings on legs Clexane injection |
Staff will show you how to inject Clexane |
Continue injecting Clexane for 28 days once discharged |
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 |
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
|
Try to eat and drink normally. You might prefer to eat little and often.
|
Try to eat and drink normally. You might prefer to eat little and often. |
Try to eat and drink normally. You might prefer to eat little and often. |
Personal Care |
Dress in your day clothes |
Dress in your day clothes |
Dress in your day clothes
|
Fifth to Seventh Day after Operation
(Days 5-7)
You will be discharged today, if:
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Your blood pressure, temperature, pulse and breathing are all stable.
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Your blood test results are at acceptable levels.
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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 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 the consultant’s secretary on 01752 432150.
If you have any concerns or problems, please ring:
Stonehouse Ward 01752 431488
Wolf Ward 01752 439677
Cancer Nurse Specialist 01752 431527
Derriford Hospital Switchboard 01752 202082