Hepatobiliary Surgery

This service is supported by nurse specialists to deliver an enhanced recovery scheme to help patients recover and rehabilitate from major liver surgery.

ERAS (Enhanced Recovery After Surgery) in Liver Resection

The Enhanced Recovery Programme is about getting you fit before surgery and safely speeding up the recovery time, as well as reducing the incidence of complications.

In order for the programme to succeed, you have to actively participate in your own recovery programme by taking responsibility for certain aspects of your care and recovery. This programme is different to traditional care and can improve your recovery considerably.

Watch the video to find out more:

What is Enhanced Recovery?

The main focus of the programme is:

• Reducing the physical stress of the operation
• A structured approach to immediate post-operative management including pain relief
• Early mobilisation
• Early feeding
• Setting nutritional and activity goals

All aspects of this programme will be beneficial to most patients while others may only benefit from certain aspects of it. Depending on your condition of health and fitness at the start, your recovery in this programme may be different from others. Nonetheless, we will try our best to help you use this programme as safely and practicable as possible to the best of your ability and needs.

Following major abdominal surgery, patients have traditionally remained in the hospital between 1 to 2 weeks. Recently, it has been shown that by altering how patients are managed both before and after surgery they can be safely discharged home in 3 to 5 days. We hope that you will achieve this by gaining some control over your recovery.

During your hospital stay there will be daily goals for you to achieve with the help of your nursing and ward staff. We will give you a patient diary to record these daily goals. Please bring this into hospital on the day of your surgery. We ask that you fill in the sections highlighted to record and monitor your progress.

Don’t worry if you cannot achieve the goals exactly as the diary describes – these are only a guide. Each person recovers from surgery at a different rate compared to others.

If there is anything you are unsure about, please ask a member of staff or call one of the numbers at the end of this booklet.

Before your operation

Pre-assessment Clinic

You will be involved in planning your care and recovery from the time that we see you in the pre-assessment clinic. This is an opportunity for you to tell us about your individual needs and circumstances. It is advisable to bring along a relative or close friend to this appointment, or someone who can also be involved and support you with planning your care and recovery.

If you feel worried or concerned about managing at home after your operation, it is important that you tell us as early as possible. You should also let us know if any of your circumstances at home change whilst you are in hospital.

We have a team of healthcare professionals who can help organise any relevant support you might need. These include physiotherapists, occupational therapists, and social workers.

At the pre-assessment clinic, you will be asked about your general health, previous operations/illnesses, allergies and any medications that you take. You may have an ECG (heart tracing) and/or chest x-ray as well as some blood tests. If necessary you may also see a doctor and/or anaesthetist.

You will be screened for MRSA to find out whether you have any of the bacteria on your skin. If your screening results come back as positive we will arrange for you to have treatment before your admission. You will be given a separate leaflet to read which will explain this in detail.

We will give you information about how to prepare yourself for your surgery, including:

• information on medication before your operation
• when to stop eating
• high energy carbohydrate drinks
• what to do on the day of your admission

Preparing for your operation

Admission to hospital

Most of our patients will be admitted to hospital on the day of their surgery. You will receive a letter or a phone call from the surgical admission team to inform you about your admission.

Fasting

You will be advised as to what time you need to fast from. Fasting means you will not be able to have anything to eat or drink after a specific time.

For most patients food needs to be stopped at 12 midnight the day before your operation, this includes:

• mints
• chewing gum
• boiled sweets
• tea/coffee with or without milk, etc.

For most patients water can be drunk until 6am the morning of your surgery.

Please read your admission letter as this will tell you what time to fast from. If you are not sure, please contact your specialist nurse on the telephone numbers at the end of this booklet.

Nutrition 

A key aspect of the Enhanced Recovery Programme is high energy carbohydrate drinks given to you before and after your operation. These will give you the much needed energy you need to help you recover.

You will be given six bottles of the carbohydrate energy drinks to have at home to provide you with extra calories before your surgery.

After your operation

Breathing and circulation exercises

Following your operation it is important that you do deep breathing exercises. With your shoulders relaxed, take a deep breath in, hold for 1 to 2 seconds and then let the breath out slowly. This should be done at least five times an hour.

You will be given an incentive Spirometer – a device that helps you expand your lungs and prevents chest infections. Whilst sitting upright, seal your lips around the mouthpiece and inhale slowly lifting the yellow ball inside the device. You will have to do this around ten times every hour. The ward staff and physiotherapists will give you instructions on how to use the device properly.

You should also do exercises to help your circulation and reduce the risk of blood clots. Circle your ankles both ways and then point your toes up towards you and then back down briskly. Doing this simple exercise ten times every hour while in bed or chair will be beneficial until you are walking regularly.

Coughing

After your surgery, it is important to keep your chest clear by coughing up any phlegm or mucus that is produced by the lungs. This is especially important if you are, or have been a smoker. This will help minimise the chances of you developing a chest infection.

Sometimes, being in pain will prevent you from coughing effectively; so it is vital that your pain is controlled enough to allow you to cough. If the pain is too severe, you must inform the nursing staff who will alter your pain relief medication. Your wound is designed to withstand the pressure of coughing, so don’t worry about doing any damage. It is easier to cough if you sit forward, and if you use a pillow or rolled up towel pressed firmly over the wound to support your coughing muscles.

Meet the team

The ERAS team is compromised of a wide range of multi-specialty professionals. As part of your journey you will meet many of the following:

• Surgeons
• Anaesthetist
• ERAS clinical nurse specialists
• Nurses
• Theatre staff
• HPB clinical nurse specialists
• Physiotherapists
• Dieticians
• Clinical support workers