The probable diagnosis and the appropriate treatment plan will be discussed in detail with the patient during outpatient clinic consultation. The patient is usually seen by the anesthetist at least once prior to admission to assess his/her fitness to undergo the procedure. Liver and pancreatic surgeries are major operations and it is important that any additional risk factors such as heart disease, lung problems are identified beforehand. The patient may need additional investigations of the heart and lungs and treatment prescribed by the specialists. This helps in optimizing the health condition before surgery.
Day of Surgery
You will be admitted the evening prior to planned surgery when you will be reviewed one final time by the anaesthetist and surgeon. They will go through the details of the operation with you and obtain legal consent from you and your family to proceed with surgery.
Once the surgery is completed, you will be in the ICU for 1-2 days although this may be longer depending on the nature of operation. You will be shifted back to the ward after this, and will remain there till discharge.
During the recovery period you will be on intravenous fluids for about 3 days although you will be given fluids orally from the evening of surgery. Intravenous fluids are discontinued once you are able to drink enough without nausea or abdominal discomfort. It normally takes 3-4 days for the bowel to recover after abdominal surgery, so you may feel some distension early on that is relieved once you pass flatus or stools.
You will have a plastic tube placed in the abdomen at the end of the operation to drain excess fluid from within the abdomen. This is initially blood stained but rapidly clears to being straw-coloured. The drain is normally removed 3-5 days after surgery but may need to be left for longer on occasion. A urinary catheter will drain urine but is usually removed about 3 days after surgery. You will be asked to wear white stockings to prevent blood clots from forming in your legs.
Total hospital stay is usually 5-7 days after liver surgery and 10-12 days after major pancreatic surgery.
Pain control after surgery
Pain is well controlled in the postoperative period initially with epidural anaesthesia, which numbs the region of the wound. This is very effective and can be administered for 3-5 days after surgery to deal with the period when wound pain would be at its worst. After 3-5 days the pain is less, and is well controlled with tablets of Paracetamol and mild morphine derivatives.
How to speedup up your recovery
The nurses and physiotherapists will work with you in the ICU and ward to ensure you cough up any mucus from the lung to prevent postoperative lung infection. They will also get you out of bed and sitting in a chair or walking to prevent blood clots in your legs and to help your bowel function to recover faster. It is advisable that you cooperate with the mas the more actively you mobilise, the more quickly you will feel better and be ready to go home! If your mobility is affected due to pain at the surgical site, do not hesitate to inform the doctors or nurses, as you may need more painkillers to be comfortable.
What are the risks of surgery?
Liver and pancreatic surgery is now quite safe, particularly in specialized centres. The risk of mortality is below 2-3%. Complications do occur occasionally but can usually be effectively dealt with without lasting effect. Complications specific to liver surgery include bleeding, bile leakage and postoperative liver dysfunction. Complications specific to pancreatic surgery include bleeding, anastomotic leakage and delayed recovery of gastric function. Late complications include diabetes and weight loss that may be corrected with medication.