Procedures

Laparoscopic Pancreatic procedures

• Types of pancreatic surgery
• Risks
• Pre operative information
• Information about the day of surgery

• Length of recovery
• Post operative information
• References

Types of pancreatic surgery:

• 1. Pancreatic Tumor
• a. Whipple operation
• i. Laparoscopic Whipple operation
• ii. Open Whipple operation
• b. Central pancreatic resection (Median or Middle pancreatectomy)
• c. Distal pancreatic resection
• i. Laparoscopic distal pancreatectomy
• 1. Laparoscopic distal pancreatectomy with splenic preservation
• 2. Laparoscopic distal pancreatectomy with splenectomy
• ii. Open distal pancreatectomy
• d. Pancreatic enucleation
• i. Laparoscopic pancreatic tumor enucleation
• ii. Open pancreatic tumor enucleation
• 2. Chronic pancreatitis
• a. Pseudocyst drainage procedure
• i. Laparoscopic cytogastrostomy
• ii. Laparoscopic cystoduodenostomy
• iii.Laparoscopic cystojejunostomy
• b. Peustow’s operation ( pancreaticojejunostomy
• i. Laparoscopic Peustow’s Operation
• ii. Open Peustow’s operation
• c. Berger operation
• d. Frey operation
• e. Resection
• i. Whipple operation (laparoscopic whipple or open
• ii. Distal pancreatic resection

Risks:
The significant risks of this procedure are: bleeding, infection, pancreatic leak, recurrent cancer, and delayed gastric emptying.

Pre operative information:
Before your surgery, you will be required to have a pre admission testing appointment. At this appointment, you will be registered at the hospital; you will have lab work done and possibly a x-ray. You will also meet with an anestheologist.

Information about the day of surgery:
No food starting midnight the night before surgery. Solid food must be avoided the day of surgery-regardless of the surgery time. Clear liquids must be stopped four (4) hours before your surgery.

Clear liquids are considered: water, apple juice, cranberry juice, black coffee (no cream), tea, and soda (7-UP, pepsi, ect).

Length of recovery:
You will be allowed to go home around 7 days after the surgery.

Post operative information:
General Abdominal Surgery Post-Surgery Guide

The following information is intended to guide you through your post-op recovery:

Diet:
· For the first few days after your return home you should eat foods that you easily tolerate normally.

Medications:
Follow the directions on any new prescriptions that your doctor has given you. You may return to taking your regularly scheduled medications on the day of your surgery, unless your doctor has directed you otherwise.
Pain management is an important part of your post-surgery care. You should expect some discomfort after your surgery. You may be sent home with a prescription for pain medication. It is important to take your pain medicine prior to your pain becoming intense in severity.
PLEASE NOTE: No pain medication refills will be authorized on the weekends. If a refill is needed, the request must be made before 12:00 noon on Friday.
Some side effects from the pain medications include nausea and constipation. If you experience nausea or vomiting related to your pain medications, you should stop the medication and take ibuprofen or acetaminophen for pain management.

Bowel Care:
To prevent constipation you should drink plenty of fluids and take a stool softener daily.
If you have not had a bowel movement within 48 hours after your return home, you should increase your fluid intake. You may take one single dose of Milk of Magnesia, as long as you have no abdominal distention.

Incision Care:
Please leave your dressings on for 48 hours after your surgery. Unless your doctor specified otherwise you may then remove your dressing and shower. Remove the outer dressing and leave the strips of tape that cover your incision.
You may remove the gauze dressing over your incision 48 hours after your surgery. Please leave the skin tapes in place for approximately 7-10 days.
If your clothes irritate the incision or if you have some drainage you may leave a dry gauze dressing over your incision.
You must observe your incision daily for signs or symptoms of infection. These signs would include: increased swelling, redness or smelly wound drainage. It is normal to have some swelling and bruising around your incision. It is normal to have a firm lump directly beneath your incision line. This will disappear within a couple of months.

If you have staples or stitches, they will usually be removed 2 weeks after your surgery. You will need to make an appointment to come to the office for that.
After the staples are removed you will have skin tapes / steri-strips across the incision. Those strips should remain in place for 5 to 10 days. The strips will gradually loosen and come off. If they do not come off within two weeks you may remove them yourself.

Physicial Activity/Restrictions:
· Upon your return home you should begin a daily walking program that will gradually increase. You should start walking inside your home initially and then gradually increase to walking around your neighborhood. Every patient will have to individualize their walking according to their general status.
· You may resume sexual activity when it is comfortable.

Bathing and Showering:
You may shower after you remove your dressing which will be 48 hours post-surgery. You may shower with your steri-strips in place. Do not scrub across your steri-strips. Do not bathe in a tub for 10-14 days after your surgery. This includes a “hot tub”.

Driving:
You may drive when you no longer are taking narcotic pain medications and you feel you can quickly respond to situations that will not place others in jeopardy.

Return to Work:
· Your doctor should inform you of when you might return to work. Please notify our office if you need a return to work letter to your employer. It may take up to 48 hours for the letter to be completed. Please leave a fax number for your employer so we can fax your release.
· The following will give you a guide for when you might be able to return to work or school:
Light lifting or no lifting type jobs: No lifting over 10-20 lbs. for 4-6 weeks after surgery.
Heavy lifting or physical type jobs: You may return to this type of activity 6-8 weeks after surgery.
· Usually you can begin to increase your lifting weight gradually 4-6 weeks after

Follow-up Appointments:
You will need to return to the office for a follow-up visit usually within 2 weeks after your surgery. Please make sure you have your appointment scheduled.

Problems to Observe For:
Call the office for the following:
1. Fever >101.0
2. Uncontrolled pain. That is on a scale of 1-10 (10 being the worst pain imaginable) your pain is a level 7 or above.
3. Nausea and / or vomiting that continue for 12-24 hours.
4. Diarrhea that continues for 12-24 hours.
5. Signs of a wound infection.
6. Chest pain or difficulty breathing
7. Your incision separates or opens up.

If you have further questions after reading this handout, the office is open from 9:00AM to 5:00PM Monday through Friday. For emergencies after office hours, the answering service will be available when you call the office number.