What happens after surgery depends on the type of operation you have had. You usually stay in hospital for at least a few days.
Straight after pancreatic surgery
You will probably wake up in intensive care or a high dependency recovery unit if you have had very major surgery to try to cure your cancer. They can be busy and noisy places and you might feel a bit confused.
Here you can have one to one nursing care. And your surgeon and anaesthetist can keep a close eye on your progress. As soon as your doctors are sure you are recovering well, you move back to the ward.
You might go back to the ward straightaway if you have had a smaller operation.
Drips, drains and tubes
When you wake up, you have several different drains and tubes in place. This can be a bit frightening. But it helps to know what they are all for.
You might have:
- drips (intravenous infusions) to give you fluids until you are eating and drinking again
- tubes into your neck and arms to measure your blood pressure
- one or more tubes coming out near your wound to stop fluid and blood building up there
- a tube down your nose into your stomach (nasogastric tube) to drain it and stop you feeling sick
- a tube into your bladder (catheter) to measure how much urine you pass
- a fine tube into your back that goes into your spinal fluid (epidural) to help relieve pain
Your blood pressure
You might have a blood pressure cuff on your arm and a little clip on your finger to measure your pulse. Keeping your blood pressure stable is very important. So, your nurses will measure your blood pressure regularly. At first, they can monitor it through the tubes that go into your neck and arms. These go directly into your main blood vessels and give a more accurate measurement than a blood pressure cuff on your arm would.
Your nurses will also check your urine output because it can help to show whether you have too much fluid or are becoming dehydrated.
Your insulin level
You might have another pump containing insulin. This is likely if you have had major surgery to your pancreas. It is important to keep your glucose levels within the normal range. Your nurse tests your blood glucose every hour or two at first. The pump is set to give you just the amount of insulin you need.
Pain and pain control
You will almost certainly have pain for the first week or so. But there are many different painkilling drugs you can have. There are also different ways of having painkillers.
It is important to tell your doctor or nurse as soon as you feel any pain. They need your help to find the right type and dose of painkiller for you. Painkillers work best when you take them regularly.
You might have a tube to give anaesthetic drugs into your spinal cord. This is called an epidural. Or you might have a couple of electronic pumps attached to your drips. One of these might have painkillers in it.
You might have a hand control with a button to press to give yourself extra painkillers as you need them. This is called patient controlled analgesia, or PCA. If you have this, do use it whenever you need to. You can't take too much painkiller because the machine is set to prevent that.
Tell your nurse if you need to press the button for extra painkillers very often. You might need a higher dose in the pump.
You might also have some painkillers as tablets or liquid that you swallow, or by injection.
Eating and drinking
After surgery to any part of the digestive system, the bowel often stops working for a while. You won't be able to eat or drink straightaway and so you have fluids through a drip.
You might be very run down and malnourished, if you were ill for some time before your surgery. This is because the pancreas normally produces enzymes that help us digest our food. You may need extra help with nutrition to start with. There are several ways you can have help with this.
Help with getting calories
You might have a white liquid called TPN through your drip. This stands for total parenteral nutrition. It contains proteins, fats and carbohydrates that are easily absorbed by the body. Or you may have liquid food through a tube that goes down your nose and into the stomach (a nasogastric tube). Or you may have a tube into your stomach or bowel through the wall of the abdomen.
Your surgeon tells you when you can start drinking again. You start with sips of fluid, often a day or two after surgery. Gradually the amount you are allowed to drink increases, before slowly moving on to more solid foods. Once you can drink without being sick, your nurse will take out your drip and nasogastric tube.
In some hospitals, you start drinking nutritional drinks the day after your operation. You build up the amount you drink over the first few days. As long as you don't feel sick, you can then try eating food.
The wound from the operation is covered up when you come round from the anaesthetic. It is left covered for a couple of days. Then your nurse changes the dressings and cleans the wound.
The bags or bottles attached to your wound drains are emptied and changed every day. When they have stopped draining fluid they are taken out. This is usually about a week after your operation but might be longer if there is any fluid leakage in the operation area.
Your clips or stitches are left in for about 7 to 10 days if they are not dissolvable. Your district nurse or practice nurse can remove them if you are at home.
Some surgeons leave a small tube (stent) inside you to help drain fluid from the pancreas after your surgery. They take this out about 3 weeks after the operation. You usually have this done in outpatients.
Getting up might seem very difficult at first. Moving about helps you to get better, but you will need to start gradually. Your physiotherapist will visit you every day after your operation to help you with your breathing and leg exercises.
Your nurses and physio will encourage you to get out of bed and sit in a chair, usually the first day after your surgery. They help you with all the drips and drains. They will also help you to walk on the spot to help encourage blood flow around your body.
Over the next couple of days, you sit in your chair for longer periods and start going for longer walks around the ward. The tubes, bottles and bags will start to be taken out. Then, it is much easier to get around and you will really feel that you are starting to make progress.
You might stay in hospital for about 10 to 14 days. But some people may need longer to recover. Some hospitals have an enhanced recovery programme where they aim to have most people home within 7 days of surgery.
Insulin and digestive enzyme replacement
If you had part of your pancreas taken out, you will probably still make enough insulin. Your doctor will need to keep a very close eye on your blood sugar to make sure you don't develop diabetes.
You might not make enough digestive juices but can take supplements of pancreatic enzymes to help you digest fat. These usually come as capsules that you swallow.
If your pancreas was completely removed, you will have to take pancreatic enzyme supplements and insulin. Because you won't be making your own insulin, you will effectively have diabetes.
You have insulin as a small injection under the skin. You will have to check your blood sugar levels regularly. You do this by pricking your finger and squeezing a drop of blood onto a testing strip.