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Date issued: July 2022

Review date: July 2024

Ref: A-497 

PDF:  Short Stay Liver Pathway patient leaflet final July 2022.pdf [pdf] 315KB

Contents page

Introduction

Chapter 1

• The Liver

• Functions of the liver

• Enhanced Short Stay Liver Surgery Pathway

• Types of surgery that are eligible for Enhanced Short Stay Liver Surgery

• Possible risks and complications associated with surgery

Chapter 2

• Pre-habilitation preparing for surgery

• Pre-assessment

Chapter 3

• Day of operation

• Post-operation hospital stay

• Planning your hospital discharge

Chapter 4

• Post-operation at home

Chapter 5

• Who can I contact if I have any questions?

• Helpful contacts

• Further information

Introduction

You have been referred to University Hospitals Plymouth for liver surgery.

You may be surprised that you have been asked to receive treatment here, even if you do not live locally.

Studies have shown being treated at a specialist centre, such as University Hospitals Plymouth, results in better outcomes and reduces the chances of complications for patients. This is due to the increased skill and expertise of the multi-disciplinary team involved in all aspects of your care, and the increased number of patients being treated in one place.

In 2006, liver surgery in Devon and Cornwall became centralised to University Hospitals Plymouth. Therefore, instead of small numbers of operations being done in several hospitals, all these operations are now done in University Hospitals Plymouth. We now perform two or three liver operations every week.

We appreciate that life may feel like an emotional roller coaster at the moment. You may have many questions and anxieties regarding liver surgery, your hospital stay, and financial concerns.

This booklet has been prepared to try to address many of these questions and more. It will hopefully supplement the information given to you by your doctors, surgeons, specialist nurses and ward nurses. It may not cover all your concerns so if you have any other questions or worries after reading this booklet, please don’t hesitate to contact one of the staff listed towards the end of the booklet.

Your relatives and close friends may also wish to read this booklet, to answer their questions and concerns, and to help them understand the treatment you will be undergoing.

The recommendation for you to have liver surgery has come from the full ‘multi-disciplinary team’, consisting of liver surgeons, oncologists (cancer specialists), radiologists (X-ray doctors) and specialist nurses; it will not be the recommendation of a single surgeon.

Your wishes about treatment will be discussed with you and respected at all times by your surgical team. Other treatment options can be discussed with you and can be arranged within your local hospital as appropriate, if you decide to not undergo liver surgery.

Chapter 1

The Liver

Firstly, it is important that we mention the anatomy and function of the liver.

Functions of the Liver

The Liver’s main job is to filter the blood coming from the bowel, before passing it to the rest of the body. The liver has multiple functions. It makes many of the chemicals required by the body to function normally, it breaks down and detoxifies substances in the body, and it also acts as a storage unit.

The liver has the amazing ability to regenerate when a part of it has been removed. This ability has allowed liver surgery over the years to progress and become more extensive with more success.

Enhanced Short Stay Liver Surgery Pathway

You have been placed on this pathway as you have been identified as a suitable candidate for discharge within 24 hours following liver surgery.

This means that you have been assessed as having a good level of fitness and health and the type of operation you require allows you to be ready for discharge from hospital within 24 hours.

Types of Surgery that are eligible

• Laparoscopic (keyhole) liver surgery.

• One or two wedge/segments of the liver to be removed

• Radical Cholecystectomy (removal of the gallbladder and surrounding lymph nodes).

• Left lateral liver resection (removal of segments 2 and 3)

• Isolated removal of particular lymph nodes.

Possible risks and complications associated with surgery

In the telephone and face to face clinic at University Hospitals Plymouth we will explain the aims of the operation and the potential benefits and risks. On the day of surgery, the surgeon will go through these again and you will be asked to sign a consent form saying you give permission for the surgeon to perform the operation.

No treatment can be given to you without your consent and before you are asked to sign you should have been given full information regarding the benefits and risks of the proposed operation, plus possible alternatives. Please keep asking questions until you are satisfied that you have all the information you need.

As with all major operations, the surgery and the anaesthetic carry risks to your health. Some of the risks/ complications of this operation are serious and can be potentially life-threatening. There is a 5% chance of some sort of complication as a result of this operation. They range from mild to severe and will be explained below. You will be under the care of a specialist team of doctors and nurses, who will monitor your condition to make sure that any complications that occur are treated as soon as possible.

Bleeding

With any operation there is a possibility of bleeding in the hours after the operation. If this occurs you may require further tests (CT scan).You also may need a blood transfusion or in a few cases another operation.

Bile leak

A bile leak is a result of bile leaking from the cuts made into the liver as the bile ducts are interrupted during surgery. These are cauterised at the time of surgery but leaks are still possible as the wounds heal.

You may need more scans and tests and the plastic drain tube coming out of your abdomen will be left in place to drain the fluid off until the leak has stopped. If a leak develops you are likely to be in hospital for longer than 24 hours

The surgeons and nurses will check regularly for signs of a leak so it can be treated early on. In most instances a leak settles down on its own.

Chest infection and problems with breathing

Due to the wound/wounds on your abdomen you may find it difficult to breathe deeply or cough, which may lead to a chest infection. The nurses will teach you deep breathing exercises to help prevent a chest infection (they are also detailed later in this booklet). It is important that you tell us if you have any pain as this will make it harder for you to do your exercises.

If you smoke you are more likely to develop a chest infection after your operation. It would benefit you greatly to stop smoking before your operation.

Wound infection

The surgical cut/cuts (wounds or incisions) on your abdomen can sometimes develop an infection. The nurses will check your wound for any signs of infection and keep the wound/wounds clean and dry. If an infection does develop you may be given antibiotics. If you are diabetic you are more at risk of infection. Ensuring your blood sugar is stable and below 10mmols can reduce this risk prior to surgery.

Chyle leak

Rarely, there may be a leak of milky liquid called chyle (lymph fluid) into your abdominal drain after surgery. This is treated by restricting certain things from the food you eat for a period of time. A chyle leak usually reduces and stops over one or two weeks.

General anaesthetic complications

Liver surgery is a major operation and is done under general anaesthetic. This means that you will be unconscious and unaware of anything during the operation.

The majority of the risks relate to the operation itself. However, there are also risks to other organs, such as your heart and lungs. Major surgery such as this places a strain on the body’s resources; the risks for any individual patient are different and are assessed person by person.

Blood clots (Deep Vein Thrombosis)

The risk of blood clots in the legs and/ or going to the lungs is increased post-surgery. Moving around as soon as possible after your operation can help to prevent this. You will also be given daily injections to help thin your blood to reduce the risk of blood clots. These injections are called Clexane and will need to continue for 28 days post-surgery. You and your relative can be show how to administer this prior to discharge home. If you feel this is not possible we can arrange a Practice/ District Nurse to administer.

Risk to life

The majority of people recover fairly well from liver surgery and are ready for discharge from hospital within 24 hours. Most complications are relatively minor and just slow down your recovery a little, but some can be much more serious and may mean you stay in hospital for much longer than you expected.

There is a very small risk that a combination of some of the complications described above may lead to an extended hospital stay and might ultimately lead to you dying as a result of liver surgery.

If you are in reasonably good general health then the risk to your life is about 0-2%; put the other way round, your chances of surviving the operation are 98-100%.

Chapter 2

Pre-habilitation- preparing for surgery

How can I prepare for the surgery?

Having liver surgery will put a strain on your body, particularly on your heart and lungs. You will have a lot of tests to help assess whether you are able to have surgery and are suitable for Enhanced Short Stay Liver Surgery pathway, but there are some things that you can do to prepare yourself. The three important areas for you to work on are:

1. Stopping smoking and alcohol

2. Eating healthily

3. Exercising regularly

Stopping smoking

In addition to the general health risks associated with smoking, research has shown that smokers are more likely to suffer complications during and following surgery.

There is evidence to suggest the following benefits if you stop smoking before surgery:

1. Reduced risk of heart and lung post-operative complications

2. Faster wound-healing

3. Reduced length of stay in hospital

Even stopping smoking for three to four weeks before surgery will decrease your risk of getting complications. The longer before surgery you can stop the better.

Help is available through the NHS so please talk to your GP or Specialist Nurse.

Stopping alcohol

If you drink a lot of alcohol we recommend that you reduce the amount that you drink prior to your surgery. Alcohol can reduce the function of your heart and can affect your liver. It can also cause mild dehydration. However, reducing high alcohol intake suddenly when you come into hospital can also cause serious health problems, so it is better to cut down well in advance.

Help is available through the NHS so please talk to your GP or Specialist Nurse.

Eating healthily

Having a healthy balanced diet is important to maintain a healthy weight. It allows your body to cope with the stresses of surgery.

Specialist dietitian support is available prior to your liver surgery if required.

Exercising regularly

Keeping fit and active as much as possible before liver surgery will help your recovery afterwards. For example walking 2-3 miles (on the flat/hill depending on your fitness level) every day will help keep your heart and lungs working well, and keep you in good condition ready for your operation. If this is not possible even walking up the stairs a couple of times a day and ‘getting out of breath’ can make a difference to your heart and lung function.

Respiratory (breathing) exercises

Respiratory exercises performed before and after surgery can help reduce the risk of lung problems by opening up your airways and moving phlegm. Respiratory exercises, coughing and walking after surgery can prevent post-operative chest infections and reduce your length of stay in hospital.

Practising respiratory exercises before your operation will make it easier to perform them afterwards. Here is a five step guide to breathing exercises:

1. Sit upright in a supported chair.

2. Breathe in and out normally.

3. Take a slow deep breathe in so that your ribs expand sideways and your lungs fill up with air and then breathe out.

4. Take a slow deep breathe in and expand your lungs, hold that breathe for three seconds and then slowly breathe out.

5. Repeat three times.

If you feel dizzy or tired, return to breathing in and out normally.

Practice these respiratory exercises prior to surgery. After your operation you should do them every one to two hours.

Psychological wellbeing

We know that providing good quality personalised information for you and your relatives’ leads to reduced anxiety, improved patient experience and better surgical results. We aim to give you information and support during all stages of your surgical experience. Information is normally provided by your Surgeon, Specialist Nurses, ward nurses and the allied health professions.

It is important for us to consider how you are thinking, feeling and coping with your diagnosis and treatment at all times. Everyone in the team will be open to discussing these aspects with you at any time. Hopefully you will get a lot of reassurance from speaking openly and feeling understood by your healthcare professionals. There is added psychological and counselling support in your local Cancer Centres. Please see section on Cancer Support Centres.

Preparing your return home

Before your operation, it’s a good idea to start thinking about transport arrangements and how you will manage at home after surgery, especially in the first few days and weeks. We encourage patients to have a relative stay with them for the first week or so after returning home if possible.

If you live alone or require additional support, then please speak to the Surgeon/ Specialist Nurse and/ or ward nurses. The sooner we know this, the sooner we can start arranging something for you with the Ward Discharge Team. Talk to your close family, friends and GP to see what options you have.

Enhanced Recovery Programme

We have developed an Enhanced Recovery After Surgery (ERAS) programme for the Enhanced Short Stay Liver Surgery Pathway. This process aims to ensure that you are discharged as early and as safely as possible with the best possible outcome.

You will be given leaflets before surgery about your role and recovery in hospital post-surgery. This will help you understand what to expect and when to expect it.

Hearts Together Hospital Hotel accommodation

For patients and relatives who have a long way to travel    there are a number of local hotels including ‘Hearts Together Hospital Hotel’ formerly ‘The Lodge’. Hearts Together provides accommodation for relatives, friends and carers of patients undergoing treatments in University Hospitals Plymouth. The accommodation is of a very high standard at affordable prices.

There are self-catering facilities and breakfast is provided. There is a small but excellent team who are both helpful and supportive. Hearts Together is within walking distance of Derriford Hospital (10 minutes) and a courtesy bus is provided for guests during the week at specified times. It is situated on the edge of a local nature reserve. Take a stroll through the gardens or relax on the balcony, taking in the beautiful views. Their telephone number is provided at the back of this booklet. The Pandemic has changed some aspects but hopefully normal activity will resume soon.

Cancer Support Centre The Mustard Tree

(Derriford Hospital)

If you are having liver surgery as a result of a cancer diagnosis and you or your family would like the opportunity to talk to someone about how you feel or just want a break from the usual routine we invite you to contact the Mustard Tree. The centre is available to anyone affected by cancer at any stage of the illness and offers a comfortable space where you can share your concerns, ask questions and receive support. It is staffed by professionals and trained volunteers many of whom have a personal experience of cancer.

The centre is open Mon–Fri 09.00–5.00 and is located on level 3 of University Hospitals Plymouth by the Royal Eye Infirmary entrance. Their telephone number is provided at the back of this booklet.

Other Cancer Support Centres in Devon and Cornwall if you are not local to Plymouth are as follows. Telephone numbers for these can be found via the Specialist Nurse or the Mustard Tree Cancer Support Centre-

Triangle Centres

 Kingsbridge Hospital (Tue 10.00-4.00)

 Liskeard Hospital       (Thur 10.00-4.00)

 Tavistock Clinic          (Fri 10.00-4.00)   

 

The Cove  Treliske Hospital, Truro.

The Force  Royal Devon and Exeter Hospital, Exeter.

The Lodge South Devon District Hospital, Torbay.

The Over and Above Fern Centre- North Devon District Hospital.

The Coronavirus Pandemic has changed some aspects but hopefully normal activity will resume soon.

Pre-assessment

Before your operation and anaesthetic we will need to know about your general health, any previous or current illnesses and your medication.

You will have an appointment at our pre-assessment clinic where several members of the team will assess your health and prepare you for the operation and anaesthetic.

Healthcare Assistant

A healthcare assistant will measure your height, weight, blood pressure and may carry out an ECG (electronic tracing of your heart). They will also take bloods to check your iron levels and the function of your kidneys and liver. You will also have swabs taken to screen for MRSA (Methicillin Resistant Staphylococcus Aureus).

Nurse

The nurse will ask you a number of questions to assess your fitness for a general anaesthetic and liver surgery.

The nurse will ask about the medicines you are taking, including herbal remedies and any supplements that you may be taking. Please bring a current list of your medications with you. Some medications (including Aspirin, Warfarin or Clopidogrel) make your blood thin and may result in you experiencing excessive bleeding during the operation. You may be asked to stop these medications a few days before the operation to allow their effects to wear off. You may be given an alternative treatment for those days.

The nurse will also give you verbal and written information about preparing you, your family and friends for your operation and stay in hospital. They will check you have information on the ‘ERAS’ pathway after surgery. The ‘Planned Surgery’ booklet will also be given, which explains some practical aspects of coming into University Hospitals Plymouth for an operation.

Anaesthetist

The anaesthetist will review the information gathered by the healthcare assistant and nurse and will discuss the anaesthetic and pain relief options with you.

You will be asked to do a Cardiopulmonary Exercise Test (CPET). This will involve a test on a static exercise bike; you will have been sent an information sheet explaining this. This is to see how well your heart and lungs are working. It gives the anaesthetist immediate information on your fitness and the anaesthetist will discuss the risks of surgery for you at this appointment. Post-surgery you will have a Level 1 bed on Stonehouse or Wolf wards.

If there are any concerns about the results of your test the surgeons may want to see you in clinic again before you proceed to surgery.

COVID Swab

You may be required to have a COVID swab 48hrs before the operation. This can be done at your local hospital if you let us know in advance, otherwise this will be arranged at Derriford hospital.

Chapter 3

Day of Operation

You will be asked to come into University Hospitals Plymouth, the Planned Care Treatment Ward on the day of your surgery for 7am.

You will have received information about when to stop eating and drinking in your operation notification letter. If you are diabetic a special regimen of glucose and insulin will be given through a drip and your blood glucose level will be closely monitored.

Consent

Your surgeon will discuss your operation with you again including the expected benefits and the potential risks involved. It’s important that you understand the benefits and risks involved in the operation before you sign the consent form. If you have any questions or concerns, please ask the surgeon before the operation. It is never too late to have second thoughts, but the hope is that all of your questions will have already been answered either when you came to clinic or subsequently by your Specialist Nurse.

The Operation

You will be asked to put on a theatre gown and TED stockings (prevent blood clots). You will be taken to the anaesthetic room in the operating department by one of the nurses.

The operation time will depend on the type of surgery you are having. But the liver surgery can usually take between one to three hours. After the operation, you will be taken to the recovery area adjacent to the operating theatre for about 2 hours while you fully wake up.

If the Consultant Surgeon has met your relative on the day of surgery and has a contact number, there may be an opportunity for the Surgeon to let your relative know how the operation went and how you are progressing. This is only possible if you give your consent.

Before your operation you will have undergone certain tests or scans to check whether the Enhanced Short Stay Liver Surgery pathway is appropriate for you. These tests are a good guide but they cannot always give us a completely clear picture and further problems may be discovered during the operation where the procedure is more extensive or not possible. The surgeon will explain the reasons when you are fully awake and the alternative treatments that you may require.

All the tissue that is removed by the surgeon during your operation will be sent to the Histopathology Department to be analysed. This is where specialist doctors look at the tissue under the microscope to determine the exact nature of the problem. The results of this usually take at least 4-5 weeks and will be discussed with you at your follow up telephone or face to face clinic appointment.

Sometimes this may take longer if further work on the specimen is required.

Post operation hospital stay

After your time in the recovery area, you will be transferred to the Level 1 facilities on Stonehouse Ward or Wolf Ward.

There are a number of checks, which are normal and are part of the routine care for anyone undergoing Liver surgery. The ward nurses will regularly monitor the following:

Breathing and Oxygen Levels

Following your anaesthetic, you will require some extra oxygen to help you recover. This will either be given through a face mask or nasal prongs. Your oxygen levels will be monitored with a small probe that sits on your finger.

It is important to carry out your breathing exercises and cough, which will keep your lungs clear and prevent a chest infection developing. Your stomach may hurt, so please ask the nursing staff for pain relief if you are unable to breathe deeply or cough easily. You may be more comfortable to cough if you lean forward when sitting up and support your wound firmly with a pillow or a rolled-up towel.

Blood pressure, pulse and temperature

Your blood pressure and pulse will be closely watched to check for any signs of complications after your operation. Your temperature will be monitored to check for any signs of infection. A sharp rise in your temperature may indicate that you have an infection although it is normal within the first 24 hours of surgery for your temperature to increase slightly as part of your body’s normal response to your surgery.

Tubes/ drains

When you wake up after your operation you will have some tubes attached to you. These will have been placed whilst you were asleep under anaesthetic. They may be uncomfortable at times but they are essential and we will remove them as soon as you recover.

You may have some or all of the following tubes:

1. A thin tube (drip) in the vein in your neck to give you fluid and certain medications (central venous catheter).

2. A tube (drip) in your vein in your arm to give additional fluids and medication (peripheral venous catheter).

3. Near to the site of the operation (your wound), you may find a drainage tube (abdominal drain) that goes through the skin into the abdomen. This collects excess fluid from the operation site.

4. A urinary catheter (fine tube) will have been placed into your bladder to collect urine into a bag.

The tubes and drains are usually removed on day one after the operation. Some patients will still have a tube coming out of their abdomen when they go home. If this is necessary for you, we will make sure that you understand why it is there and know how to look after it until we remove it in the post operation clinic appointment. This may mean that your stay in hospital is longer than 24 hours.

Pain control medication in hospital

Depending what you and your anaesthetist have discussed at your pre-assessment appointment will determine the type of pain control you will have.

The amount of pain you will experience is variable and individual, but we will work with you to ensure that pain is kept to a minimum. It is important you tell the nursing staff if you have pain, discomfort, or if there is any change in the amount of pain you feel. It is essential that you are comfortable after your operation to allow you to breathe properly and to help you move about as soon as possible.

Oral liquid morphine

This is usually given 2-4 hourly when you are able to drink.  

Personal Hygiene

Initially you will require help with your personal hygiene whilst in hospital, but you will regain your independence. Once your drains have been removed and you are feeling well enough you will be able to have a shower.

Mobilisation

If possible you will be encouraged to lay upright in bed and sit out in the chair on the day of surgery with support depending on the time you get back to the ward. Then a short walk the day after the operation will be encouraged with support. This will help prevent stiffness, bed sores, constipation, blood clots and help keep your chest clear.

Reducing the risk of blood clots

You will be given a daily injection of a blood thinning medicine (Clexane) which you will need to carry on having for 28 days after the operation. You or your relative will be shown how to give these injections but if this is a problem we shall arrange for a District or Practice Nurse to do this for you.

Wound

Depending on the type of operation you have had will determine the wound care required. Most wounds will be glued and therefore no dressing required. The dressing around your drain site will be renewed the day after your operation. It is important to report if there is any discharge from your wounds so that it may be treated appropriately.  

Diet and fluids

You will be encouraged to start drinking freely 4 hours post operation. The day after your operation you can resume a normal diet.

Your ability to eat and drink may be affected by feelings of sickness. This is quite normal and nothing to be unduly concerned about. Please tell the nurse looking after you and they will provide you with medication for the sickness.

Bowel function

You may experience altered bowel habits for a while as a result of your surgery, lack of mobility, change in diet and strong pain killers. This is normal post liver surgery.

You may need to take a laxative temporarily to help you pass stools.

Planning your hospital discharge

You should expect a hospital stay of 24 hours. Do not worry if you need to stay in hospital for longer than this. Recovery is very individual.

Transport

Please think about transport arrangements for discharge; if you have any problems with this the nurse on the ward can arrange transport, but there may be a charge. You may be transferred to the Discharge Lounge (level 3) on the day of your discharge where you can be collected by your family or arranged transport.

Wounds

If your wound is closed with glue then there is no future wound care required. If your wound is closed with clips you should be sent home with a clip remover and wound dressings. Either the ward nurse will arrange, or you may be asked to arrange, a practice nurse or district nurse to remove the clips. These will need to be removed between 10-14 days after surgery.

Drains

If you are discharged with an abdominal drain in place, you will have a follow up clinic for assessment of the drain in 1-2 weeks. You will be taught how to empty the bag. When the bag is emptied please make a note of the amount drained so that the surgeons can make an assessment of whether to remove it at the post operation clinic appointment. Please ask for a replacement drainage bag. The ward nurse will arrange for a practice nurse or district nurse to check the skin around the drain and replace the bag if necessary.

Medication

We endeavour to arrange for your medication to be ready for you to take home in a timely manner. Unfortunately, there may be a 4-6 hour wait for this from pharmacy. Some of your usual medications may have been stopped and some new ones started in hospital, but a nurse will go through them with you before you leave.

You will be sent home on the pain medication that you are taking in hospital. You may feel you need to take this regularly to enable you to regain full mobility and be comfortable to resume normal activities. If you find that once at home you have increased discomfort because you are more mobile, please talk to your GP for advice. Some painkillers may cause constipation, in which case it may be helpful to take a gentle laxative.

Sick certificate/ Fit note

If required please ask the nursing staff to organise a sick certificate/fit note which will cover the time spent in hospital and a short period post-discharge. Please ask your GP to organise a further sick certificate if you require any additional time.

Written discharge summary

You will be given a copy of your discharge summary. This includes information about your operation, scans and if you need follow up with the GP for further tests. Your GP will be sent a copy via the post or the ward nurse may ask you to deliver this to your GP if you are happy too.

Feeling unwell at home

If you feel unwell (symptoms of increased pain, temperature or vomiting) you should contact your Specialist Nurse, GP or out of hours service. In life threatening circumstances please visit your local Emergency Department. If you are admitted to a hospital other than University Hospitals Plymouth please ask them to inform us of your admission.

Chapter 4

Post-operation at home

The following information has been designed to assist you after your hospital discharge. It covers the main questions commonly asked by patients.

You will receive a phone call the day after you have been discharged from Derriford from the Cancer Specialist Nurses to check your progress and recovery. They will also inform your local hospital team of your discharge and arrange for your discharge summary to be sent to them.

After any major operation it takes time to get back to feeling yourself again. Try to be patient with yourself and allow yourself time to recover.

Rest, mobility and activity

You may feel tired and insecure when you first go home. This is normal, and so it is important to make a plan and slowly increase the things you do over the following days and weeks.

Initially, you should avoid heavy tasks which involve lifting, stretching and pulling, e.g. pushing a shopping trolley or lifting and carrying children for at least 6 weeks.

Depending on your home circumstances, you may need to accept some help from family, friends and neighbours until you have regained your strength.

Being active is an important part of your progress at home. Being active will enable you to regain your previous level of independence and will also help you to avoid the complications that can occur with reduced activity after surgery.

Being inactive and immobile, in many instances, can be harmful and is associated with complications such as deep vein thrombosis. Therefore, we encourage you to walk daily as a good form of exercise to recover after surgery, increasing in distance over a period of days and weeks.

Blood Clot Deep Vein Thrombosis (DVT)

To help prevent the postoperative complication of DVT:

• When resting, your legs should be raised, ideally above the level of your hip. The limbs should be supported along their entirety (pillows should not be placed solely under the knees or heels).

• Active movement of your feet whilst resting should be carried out for five minutes every hour.

• Avoid standing or sitting in one position for long periods.

Alcohol

There should be no reason why you cannot drink alcohol but the effect may be felt faster than before, so be   careful.

Remember that certain medications can react with

Alcohol, always read the label.

Driving

Generally you should not resume driving until your levels of concentration, strength and mobility have improved enough for you to drive safely.

It is important to ensure you are able to perform an emergency stop and any other physical manoeuvre should be practised in a stationary car when you feel ready. It is advisable to check with your insurance company prior to driving, particularly if you are returning to a job that involves driving.

Sexual Activity

You may resume sexual intercourse once you feel confident and comfortable. Medication, hormones, chemotherapy and your general condition physically and mentally can alter your desire for and response to sex.

There is no correct time to return to sexual activity but if you experience problems or have questions, ask your Specialist Nurse or Doctor.

Wound Healing

Healing of your wound will take place over a period of time as all wounds progress through stages of natural healing.

• Do not pull off scabs as these protect new tissue underneath.

• Look for signs of infection, for example areas of redness, swelling, discharge, odour, increased pain and increased body temperature.

• It is normal for the wound to tingle, itch or feel slightly numb.

• It is normal for the wound to feel slightly hard and lumpy.

• It is normal to experience a slight pulling around the wound.

Please adhere to the rest, mobility and activity section discussed earlier as you may have an increased risk of an incisional hernia depending on the type of surgery you have. In time, if you feel this is the case, please see your GP.

Change in bowel habit

You may experience some changes in bowel habit as previously discussed.

Fatigue (Feeling exhausted most of the time), emotional impact

Everyone has good days and bad days, but fatigue is a very common experience post liver surgery. This can last for several days or weeks after treatment is complete. There are many ways of combating fatigue and many strategies which can help you manage your everyday activities.

Similarly fear, anxiety, depression and changes in mood are all possible for patients undergoing this operation. Your life may feel like it has been turned upside down, and that all your future plans are on hold. Everyone needs support through difficult periods in their life. For advice and support please contact your Specialist nurse or GP.

Back to Work

How quickly you can return to work after liver surgery will depend on the type of work you do. It can take up to 6-8 weeks. If you need to have chemotherapy after your surgery then you may find it difficult to return to work full-time until you have completed the course of treatment.

Please visit your GP to continue your sick certificate (fit note) from hospital. If you need advice regarding work and benefits, ask your Specialist Nurses who can arrange for you to see a Benefits Advisor in a Cancer Support Centre.   

When can I fly?

You will need to discuss this with your surgeon. It is not normally recommended until you are fully recovered from your surgery. Your insurance company will need to be informed of your plans for travel.

Clinical follow up

You will be offered an appointment for a telephone or face to face clinic at University Hospitals Plymouth, 4-6 weeks after discharge. At this appointment one of the surgical team will check that you are getting on as expected.

Everything that was removed at your operation will be looked at under the microscope by a histopathologist. At this post-operative clinic appointment the surgeon will go through the histopathologist’s report with you, and will discuss with you whether any further treatment is required. If further treatment is advised, the surgeons will refer you on for this in your local hospital.

We may ask you to fill in a survey on your experience at Derriford Hospital undergoing liver surgery. This will help us to continually improve the liver surgery pathway.

Chapter 5

Who can I contact if I have any questions?

The team at University Hospitals Plymouth are always willing to answer any questions you have, in an open and honest manner. The team includes your surgeon, anaesthetist, pre-assessment and ward nursing staff, dietitian and potentially a Cancer Specialist Nurse.

Any member of the team can be contacted via the numbers listed in the booklet. They are available to you, your relatives and close friends for any questions, concerns or worries throughout the whole of your treatment and after your treatment has ended at University Plymouths Hospital.

Helpful contacts

Surgeons’ secretaries                                                01752 432150/ 432805

Hearts Together Hospital  / Hotel accommodation     01752 315900

Mustard Tree (Cancer Support Centre)                      01752 430060

Stonehouse ward                                                        01752 431489

Wolf ward                                                                    01752 439677

Liver Dietitian (Plymouth)                                            01752 432838                            

Cancer Specialist Nurses

Plymouth (Derriford)                               01752 431527

Cornwall (Treliske)                                  01872 252177

Royal Devon and Exeter (Wonford)         01392 402775

North Devon                                           01271 314147

Torbay                                                   01803 655890

Further information

• www.plymouthhospitals.nhs.uk

• www.nhs.uk     NHS  Choices (England)

• www.macmillan.org.uk