Pancreatic Surgery - Preparation and Recovery

What should I expect before my surgery?

We would like you to be as fit as possible when proceeding with pancreatic surgery. Some activities that can aid in your recovery from surgery include:

• Stopping Smoking - see your GP for advice regarding help with smoking cessation. The sooner you can stop smoking the better. This will improve the oxygen delivery to your tissues, enabling them to heal faster, and will lower the rate of infections such as pneumonia or wound infections. Stopping smoking also lowers the risk of you developing a clot in your legs, known as a deep vein thrombus (DVT) which can be a life threatening condition in the weeks after surgery.
• Regular Exercise Before the Operation - every person is different but in principle the more active you can be before your operation the better
• Nutritional Supplements - some people may have lost weight or be malnourished due to their condition. In some situations it is beneficial to have nutritional supplement drinks in the period before your operation to build up your strength and decrease you risk of complications such as wounds failing to heal or infection. Commonly used options include Sustagen or Ensure, or immunonutrition drinks such as IMPACT. Your surgeon will advise whether you should consider nutritional supplements and may refer you to be seen by one of our dieticians who are experts in this area. Rarely people may need to be admitted to hospital for intravenous nutrition through a drip (TPN) or placement of a feeding tube in the gut to enable them to be adequately nourished to undergo surgery.
• Vaccinations - if you are undergoing a resection of the tail of the pancreas (Distal pancreatectomy) including resection of the spleen, you will likely need to have several vaccinations prior to your operation. The spleen plays an important role in fighting infection and after it has been removed you are at higher risk of infections due to specific bacteria such as Meningococcus or Streptococcus. Your surgeon will advise you on whether you need to have vaccinations prior to surgery. Further information and guidelines can be found on the Spleen Australia website {LINK TO SPLEEN AUSTRALIA WEBSITE https://spleen.org.au/VSR/index.html}

If you have other health problems such as heart or respiratory problems, you may be referred to a specialist such as a cardiologist for optimisation of these conditions prior to surgery or to aid in the decision as to whether you will be fit enough to undergo surgery. Let your surgeon know if you have other significant illnesses that may impact on your operation.

Often may need to see the anaesthetist prior to your operation to discuss factors specific to your anaesthetic and how to manage things like pain in the period after the operation. This may include a patient controlled analgesia (PCA), a pain button that delivers stronger analgesia such as morphine on demand, or a spinal injection at the time of the anaesthetic to provide 24 hours of early post operative pain relief.   

Can I have keyhole (laparoscopic) surgery?

Some pancreatic operations can be performed laparoscopically. This involves a number of small incisions through which a camera and instruments are placed to perform the operation. Benefits of keyhole surgery include fewer wound complications and usually a faster recovery time. There are a number of factors that need to be taken into account when deciding whether it would be appropriate for you to have a laparoscopic pancreatic operation and this is best discussed with your surgeon to make a personalised plan.

How long will I be in hospital after pancreatic surgery?

Most people will be in hospital for one to two weeks after major pancreatic surgery. You may be nursed in the Intensive Care Unit or High Dependency Unit in the first 24 to 48 hours after surgery. This surgery can be a big undertaking and there is a risk of complications such as infection, bleeding, failure of a join to heal, leaking of pancreatic juice or stressing out other organs such as your heart, lungs or kidneys. It is important to recognise such problems early and act to treat them to enable you to recover and be discharged from hospital as soon as possible. However these complications can delay your discharge. In general you can be discharged from hospital when your wounds have healed, you are tolerating a diet, you are mobilising safely, you're not in too much pain and your bowels are working. Some people may need to spend time in a rehabilitation unit, working with rehabilitation specialists, physiotherapists and occupational therapists to recover their strength and function prior to returning home.

What should I expect when I go home after surgery?

When you're in hospital the nurses are helping you with your daily activities. When you go home you will need to perform more of these activities yourself, such as showering and moving around the house. It is always helpful if you have a loved one or carer that can aid you for the first few weeks after discharge home. Often people are tired during the first few months after surgery. It is not unusual to have a nap in the afternoons whilst you are recovering. It is important to be walking around and mobile to lower the risk of developing a clot in the legs (DVT).

If you have had an open operation with a single incision you should avoid any heavy lifting for the first couple of months after surgery to lower the risk of developing an incisional hernia.

You will often be discharged home on stronger painkillers as well as paracetamol. As you recover you should be able to wean off these stronger painkillers under the guidance of your surgeon and GP.

You should see your GP the week after surgery so that they know what operation you have had and can guide you in the recovery period.

Can I drive after pancreatic surgery?

Your surgeon will guide you as when it will be safe to resume driving. You need to be no longer taking stronger painkillers and be safe to manoeuvre yourself in the car comfortably. most people will not resume driving for at least a few weeks after major pancreatic surgery.

What medications will I be discharged home on?

You will be given clear instructions by your surgeon as to what medications to take on discharge from hospital. Common medications can include an acid suppressant medication (known as a PPI) such as Somac or Nexium, stronger painkillers and anti-nausea medication such as Maxalon.  

Some people will be discharged home with a subcutaneous (under the skin) injection of Clexane to take for one month after surgery. This is a blood thinner that lowers the risk of developing a DVT (blood clot) after surgery.

After a pancreas surgery some people do not have enough underlying functioning pancreatic tissue to produce adequate amounts of pancreatic enzyme needed to absorb food. This can present with symptoms such as weight loss, abdominal pain and smelly loose stools that may float in the toilet bowl (known as steatorrhoea). Your surgeon may place you on pancreatic enzyme supplements before each meal, an example being Creon.

The pancreas plays an important role control of sugar levels by producing insulin. A percentage of people after pancreatic surgery do not produce enough insulin and can develop diabetes. This may require either oral tablets or insulin injections to manage this. Confirming a diagnosis of diabetes may require a blood test, and ongoing management is typically guided by an Endocrinologist working with your GP.

When can I start exercising after pancreatic surgery?

You should be walking around and as mobilise as possible after surgery. This lowers the risk of blood clots in the legs. Your surgeon will advise you when you can return to more strenuous activities. This can depend on whether you had a keyhole or open operation and the type of operation you had.

What can I eat after pancreatic surgery?

In the first few days after surgery you will often be placed nil by mouth whilst your organs heal on the inside. Your surgeon will progress your diet when he is happy that this is safe to do so. You will typically be given a fluid diet and this will be progressed to a solid diet over several days. You will be given clear instructions by our experienced dietitians regarding your diet on discharge. Often people after major pancreatic surgery will need to have more frequent, smaller meals in the first few months whilst they recover.