What is the risk of mortality?
Thanks to advances in surgical techniques and anaesthetic support, the mortality rate has dropped from 30% in the early 80's to less than 3% in recognised centres for liver surgery nowadays. My personal mortality rate is 0.5%, having one death in over 200 liver resections. Liver surgery is complex surgery and should only be performed by expert liver surgeons, in major referral centres.
How long does the operation take?
This depends on the type of liver resection performed. It can range from 1 to 8 hours and the average time for a major liver resection is around 5 hours.
What are the potential surgical complications?
The most common complications are bleeding, infection, bile leak and liver failure. Meticulous surgery and attention to details are paramount to reduce the risk of bleeding and bile leakage. Good knowledge of the liver physiology, careful patient selection, thorough preoperative assessment and experience in liver surgery are essential to prevent liver failure.
Are patients sent to intensive care (ITU)?
This depends on the patient's general condition and the extent of the surgical resection performed. The majority of patients do not require intensive care but spend a night or two in a high dependency unit (HDU). Patients undergoing laparoscopic liver surgery have a shorter hospital stay and shorter HDU stay. It is very rare to send patients to ITU after laparoscopic resection.
What is the average hospital stay?
Again it depends on the type of liver resection performed. For minor resections, which I perform laparoscopically in 100% of the cases the average hospital stay is 2 days and many patients are discharged after 1 day. For a major resection, if the operation is done laparoscopically the average stay is 4 days and 8 days if they are completed as an open procedure rather than laparoscopically.
Is it true that the liver grows back?
Yes, the liver is a generous organ and it has the ability to regenerate 90% of any tissue removed at resection. This process can take between 6-12 weeks for complete regeneration to take place.
Do I need chemotherapy after surgery?
This depends on the type of tumour, the patient's general condition and the disease history. However, patients are re-discussed at the MDT after surgery with the result of their histological exam. The decision for further treatment is assessed on an individual basis.
When can I go back to work?
It is very difficult to give a generic answer as this varies on the type of surgery performed (major/minor resection), the indication (malignant/benign disease), the surgical approach (key hole surgery/open surgery), general health and the patient's occupation. Patients will be seen in an outpatient clinic 2-3 weeks following discharge and return to work will be discussed and a plan agreed.
When can I drive?
This depends on your recovery and wound size. You need to be pain free and able to perform an emergency stop safely before considering driving again.
Can I drink alcohol?
Obviously if your disease is alcohol related (for example alcohol related cirrhosis) you should avoid alcohol. Otherwise it would be safe to have a glass of wine every now and then. However, it is advised that you discuss this with your doctor.
Will I have drains after discharge?
Drains are positioned to remove postoperative secretions out of the abdominal cavity. Occasionally complications occur post operatively such as internal bleeding or a bile leak and this can be quickly seen in the drains and managed accordingly. Occasionally, postoperative secretions such as serous fluids or moderate bile leaks persist for some time and are normally treated conservatively until they settle. If a patient is fit and well they may go home with a drain. This would be reviewed regularly in an outpatient clinic until such time as it was appropriate to be removed.
How often I will be seen in the outpatient clinic after discharge?
The first visit is normally within 2-4 weeks after discharge. This is to ensure normal recovery and to discuss the histological results and further management. The next check up would be after 3 months, then 6 months and then once a year for the next 5 years. This schedule may differ for some patients if circumstances change.
How I will be sure I have no post operative recurrence?
With every outpatient appointment a CT scan will be arranged and tumour markers will be regularly checked. This will permit an early identification of disease recurrence and adequate treatment if possible.
Will I become diabetic?
This is possible in around 40% of patients after pancreatic resections. This depends on the status and the size of the remnant pancreas.
How long will I be in hospital?
Average hospital stay after whipple's resection is 10 days, after distal pancreatectomy, it is 5 days if completed laproscopically and 8-10 days in open cases.
What are surgical drains?
These are plastic tubes positioned in the surgical area to ensure that any blood or fluid is drained out of the abdomen. These will be removed within 5-10 days from surgery unless there are complications such as leak. In these cases the drain is left till the leak heals. However, patients may be discharged home with a drain and reviewed regularly in out patient clinic.
When will I go back to work?
This depends on many factors including the type of surgery performed, the indication for surgery, your fitness and type of work. This will be decided with patients before discharge
When can I drive a car?
It is usually around six weeks after surgery before you can try driving again. You must be moving freely enough and able to perform an emergency stop without discomfort or difficulty.
Will I be in pain after surgery?
After key hole surgery there is less pain as there will be no large incisions. In open surgery, pain will be initially controlled with epidural, oral and intravenous pain killers. You will be discharged on regular pain killers, however at that stage there should be no significant pain but some discomfort which will continue to improve and normally resolves in 3 weeks.
Will I need chemotherapy as well?
This depends on the type of tumour and your state of health. This will be decided after discussing the histological findings in the Multidisciplinary team meeting. In almost all patients with malignant cancers, chemotherapy may offer clear advantages in terms of improving quality of life and prognosis.
Can I drink alcohol?
In the first few weeks after major pancreatic surgery it is wise to be cautious and avoid alcohol. Patients with alcohol related diseases such as chronic and acute pancreatitis alcohol should be completely stopped.
Am I going to be followed up?
Yes you will be regularly seen in outpatient clinic in the first year. Follow up will be continued based on your disease and clinical needs
Do I need regular medications following major pancreatic surgery?
Yes, in addition to any regular medication you are regularly on, you will need to take; pancreatic enzyme supplements to help with food digestion, calcium and multivitamins for life. Tablets to protect your stomach will be needed for at least 6 months.