After your surgery

• Most people are in hospital for 5 days, but this can be longer.
• You may spend the first night after surgery in a monitored unit, such as the Intensive Care Unit (ICU), where you can be watched more closely.
• After you leave this unit you will go to a general surgery patient care unit.
• Discharge time to leave the hospital is 11:00 in the morning. Your health care team will let you know when you will go home. This might change during your stay.

• You will have an incision (cut) on your abdomen over your stomach.
  • This incision (cut) will be closed with staples.
  • Your incision (cut) will be covered with gauze dressing for the first 2 days after your surgery.
  • The dressing will be taken off to let the incision (cut) heal in the open air.
  • Staples will be taken out 10-14 days after your operation.
  • If you have gone home by that time you may see your family doctor to have the staples taken out.

• You will have a urinary (Foley) catheter in place for a short time after your surgery.
  • This catheter will be taken out 1 to 2 days after surgery.
  • Once the catheter is out, you may have issues going to the bathroom and emptying your bladder. It this happens, a nurse will put a special catheter in and out to empty the bladder.

• You may see special tubes or drains near your incision (cut).
  • These help to drain extra fluid that can build up after surgery.
  • The drains will be taken out when the drainage slows down, either while you are still in the hospital or at home by a doctor or nurse.

  • If you have to leave hospital with a drain, a nurse will come to your home to help you with it.

• You may have a tube in your stomach:

  • This tube drains your stomach while it recovers.
  • It will be taken out a few days after surgery.

• You will be given blood thinners through a needle to lower the risk of blood clots.
  • You will be asked to give yourself these needles for four weeks after you leave hospital.
  • A nurse will teach you how to do the injections.

You will:

• Have some pain and aches after surgery.
• Pain around the incision area of the surgery is normal.
• Your pain will be managed with the anesthesiologist.
  • This can involve a pain pump or an epidural catheter.
  • If you have a pain pump, you will be able to press a button to get your pain medication. You will learn more about this from your nurse.
  • We will ask you about your pain every day and may make changes to the pain medications as needed.

You may:

• Feel sick to your stomach or like throwing up. You will be given medicine to help with this.
• Feel itchy from the pain medicines. Make sure you tell the nurse know if you feel itchy and you will be given medicine to help with this.
• Have gas pains in your stomach. Walking, chewing gum and drinking warm fluids can help with gas pain. Please tell your nurse if you have gas pain.

IMPORTANT: Please tell the nurse about any pain, itchiness, or if you feel like throwing up. The nurses will be able to talk with your doctor and give you medicine to help.

The types of food you will be able to eat may change depending on the type of connection that was made for your pancreas.

• If the pancreas is connected to the stomach:
  • You will have a tube in your stomach after surgery. During this time you will be able to have ice chips, but will not eat.
  • When the tube is taken out, you have a fluids diet for the first day. The next day, you will have a solid diet.
• If the pancreas is connected to the intestine (jejunum):
  • You will be able to have ice chips and sips of water on the night of surgery.
  • You will have a fluid diet on the first day after surgery.
  • The next day (second day after surgery), you will have a solid diet.
• The diet plan will be based on how well you are doing after surgery and may change. Your medical team will make a plan for your diet every day.
• Eating well will help your body heal, get strength back, and help keep your body healthy.
• For the first few days after surgery you will not be very hungry. Please only eat what you feel you can.
• After you eat your digestion may be slower than before your surgery. This usually gets better 2-6 weeks after surgery.
• Let your health care team know if you have any nausea, vomiting, or low appetite.
• It may take up to 4-6 weeks for your appetite to get back to what it was before surgery.

Ways to help with your appetite and eating:

• Try to eat small meals and snacks every few hours instead of 3 large meals per day.
• Eat your largest meal when your appetite is best.
• Try not to drink too much with meals. Fluids will fill you up faster.
• Try to limit how many low calorie foods and drinks you have (eg. Jello^®, clear soups, coffee, tea) and stay away foods labeled “light”, “low calorie” or “diet”.
• If you are eating less than usual, you may want to add a nutrition supost Plus^®, Carnation Instant Breakfast^®, Ensure Plus^®, or Resource 2.0^®.
• You may have some changes in the way food and drink tastes for the first few days after surgery.
• Before you go home you will see a member of the Clinical Nutrition team to talk about your diet.

• Do your deep breathing and coughing and leg exercises while in your bed.
• You should stay active after surgery. This will help prevent complications like blood clots.
  • You should try to spend as much time up and out of bed as possible.
  • Try to sit at the side of your bed and dangle your legs as soon as you can with help from a nurse on the same day as your surgery.
  • The first day after surgery your nurse will help you take a short walk.
  • You will have to sit up in a chair at least three times a day, or for all your meals.
  • On the second day after surgery you will be asked to walk to the hall three to five times a day. You nurse and physiotherapist can help you with this.
• You might need some extra help with moving after your surgery.
• You might need an extra hand to help you get up, or you might need to use a walker.
• You will see a physiotherapist and occupational therapist. They will help you decide what type of help you need.
  • Your family and friends can also help you do more activities.
  • Please ask your nurse for help in how to do this.

Exercises that can help after your surgery:

After your anesthesia and surgery, your circulation is a bit sluggish. To prevent complications like swelling or clots in your veins, you need to do your exercises and walk as soon as you can.

• Leg exercises help to increase your circulation. Each time a muscle is made to work (contract) the blood supply to that area gets better right away.
• These should be done 5 to 10 times every hour while you are awake during the first 24 to 48 hours after your surgery.

Ankle pumping

1. Lie flat on your back with legs out straight.
2. Point the toes of both your feet towards the foot of the bed. You will feel stretching along the tops of your legs and feet, as well as tightening in your calves.
3. Hold the position 3 seconds and then relax your toes.
4. Point the toes of both your feet towards your chin. You will feel stretching and tightening in your calves.
5. Hold the position 3 seconds and then relax your toes.

Foot Circles

1. Lie flat on your back with both legs out straight and both heels firmly on the bed.
2. Make a circle with your toes, first to the right and then to the left.

Leg Bending

1. Lie flat on your back.
2. Bend your right leg, sliding your heel along the mattress until your knee is sharply bent. Your left leg should remain flat on the bed. You will feel your heel slide along the mattress, and your calf touch the back of your thigh.
3. Straighten your leg by sliding your heel along the mattress.
4. Repeat the same exercise with your left leg.

• When you are ready to leave the hospital you will be given new medications by the doctor.
• Your doctor, nurses and the pharmacist will talk to you about how to take your new medications
• Your nurse will give you a staple remover, with instructions when to have them taken out and by whom.
• You may go home with drains after your surgery.
  • Your nurse will go over how to care for these drains before you leave.
  • You will get home visits by nurses to help you with it.
• You will have to give yourself blood thinners injections for four weeks. A nurse will teach you how to do the injections while you are in hospital.
• You might need other help in your home after surgery. Your health care team will assess your needs and set this up before you leave the hospital.
• Make sure to ask any questions or talk about any issues you may have.
• You will be asked to make an appointment with your family doctor within two weeks after you leave the hospital.
• At this appointment you will have:
  • Your staples taken out.
  • Your blood sugar monitored.
• Please give your family doctor your discharge summary. It has information on things to look for and tests to order.

• After surgery your bowels may not work the same they did before surgery.
• Some of your medications can cause constipation which means you have hard stools or cannot pass stool.
• You may also have diarrhea which is when there is too much water in your stool.
• If you have diarrhea, you may have pain or soreness around your anal area.
• If you have diarrhea:
  • Eat less fresh fruit, vegetables, and bran.
  • Stay away from foods that are greasy, spicy, or have a lot of sugar.
  • Drink about 6-8 cups of fluids a day so that you do not get dehydrated.
  • Eat small meals a few times during the day of cooked fruits and vegetables, rice, noodles, lean meats, fish, chicken, bananas, saltine crackers, and toast.
  • If your diarrhea continues for more than a few days call the GI surgical nursing line (416-480-5000 x 81061), your surgeon or your family doctor. Diarrhea may happen because your pancreas is not working properly. A doctor will give you medication if that is the case.

• Start to do more daily activities slowly. Take lots of breaks and rest as much as you need.
• Try to get out of the house each day even just to go for a walk.
• Take the pain medications whenever you need it and as instructed by your doctor.
• Do not do any heavy lifting or straining for at least 6 weeks after surgery.
• Do not lift anything over 10 pounds or 5 kg.
• Do not drive if you are taking pain medication because these medications can cause you be sleepy or drowsy.
• Do not drive if it hurts to do things like check your blind spot or turn the steering wheel.
• You can shower. Do not use perfumed soaps or lotions on your incision (cut). You can use non-perfumed soap. Use a towel to pat the area dry.
• Do not take a bath for the first week after surgery.
• You may find it hard to sit and eat a meal.
• Eat light meals until you start to feel hungry again.
• Eat foods you enjoy eating and that don’t hurt your stomach.

• Your pancreas has two jobs:
  • It releases digestive enzymes into the small intestine to help digest food, especially fats.
  • It releases insulin into the bloodstream, which helps to control blood sugar levels.
• If you had diabetes before the surgery you will likely continue to be diabetic. You should still take your medications and follow the same diet.
• If you did not have diabetes you may have some changes to your blood sugar levels, and you may even get diabetes.
• You may need to take some medications to control your blood sugar levels.
• Your stomach may not like all the foods it did before. You may find that some foods that are fatty cause loose stool and cramps in your stomach.
• Some people will need to take a pancreatic enzyme after surgery.
• These pills will help your body digest and absorb the nutrients from foods that you eat.

• Chemotherapy and sometimes radiation may be part of your treatment if your operation is being done because of cancer.
  • Your surgeon will talk to you about this when you come back for your appointment.
  • If your treatment plan includes radiation or chemotherapy you will start your treatment 6-12 weeks after your surgery.
  • If you need more treatment you will see a medical oncologist (chemotherapy doctor) and maybe a radiation oncologist (radiation doctor) after your surgery.

• You will be given a follow up appointment to see your surgeon three to four weeks after your surgery.
• Your surgeon will go over the pathology report with you (the details of the tumour that was removed) at that time.
• If you are not sure when your follow up appointment is, or have a questions about your appointment time or date, please call your surgeon’s office.
• If you have concerns before your appointment date, please contact the GI nursing line below.