Dear Valued Patient,
The purpose of this guidance is to provide you with information that will help you navigate through your hospitalization and recovery in the best and safest manner possible. Please note that this document does not replace the explanation provided by your doctor, nor does it replace the consent form for the surgery.
Background:
The pancreas is a gland located behind the stomach, approximately 51 centimeters long. The head of the pancreas is embraced by the duodenum, and its tail extends to the spleen. The pancreas assists in the digestive process by releasing digestive enzymes into the duodenum. Additionally, it secretes important hormones like insulin and glucagon, which help regulate blood sugar levels.
The Whipple procedure, also known as pancreaticoduodenectomy, is a complex and lengthy surgery within the abdominal cavity. Its main objective is to remove tumors located near the head of the pancreas, bile duct, or duodenum.
During the first part of the surgery, the surgeon examines the condition of the pancreas and the surrounding tissues. This examination is crucial to determine whether the planned surgery can be performed. Sometimes, it becomes evident that the location or nature of the tumor does not allow for the planned procedure, and in such cases, the operation may end at this stage.
If it is possible to proceed with the surgery, an abdominal incision will be made at its center. The surgery involves the removal of the head of the pancreas and other organs within the abdominal cavity. These organs typically include the duodenum, bile duct, gallbladder, part of the small intestine, and nearby lymph nodes. Subsequently, the surgeon reconstructs the digestive system by connecting the remaining part of the pancreas, the duodenum, and the bile duct to the small intestine. This connection allows digestive enzymes and bile to flow into the digestive tract (allowing food to pass from the stomach to the intestines).
Preoperative Preparation:
Before the surgery, you will need to undergo blood and urine tests, chest X-rays, an electrocardiogram (ECG), and any other tests requested by your doctor.
On the day before the surgery, you are allowed to eat regular meals until noon, excluding dairy and its products, fruit juices, vegetables, and whole grains. After that, from noon onwards, only clear fluids are permitted, such as tea, clear soup, water, and jelly. Complete fasting (no food or drink) begins at midnight before the surgery.
If prescribed by your doctor, on the day before the surgery, you will need to take a bowel preparation substance to clear the intestines.
You will be admitted to the hospital one day before the scheduled surgery, usually around 11:53 am or as instructed by the preoperative unit. (Note: In the case of surgery scheduled for Day 1, special instructions will be provided.)
Upon arrival at the surgical ward on the 8th floor, the hospital staff will receive you and complete the necessary preparations for the surgery.
You will receive intravenous hydration to provide fluids and have blood samples taken.
It is recommended to bring personal items such as toiletries, a dressing gown, and slippers.
Please refrain from bringing valuables, money, and jewelry to the hospital.
The Day of the Surgery:
Take a thorough shower.
Wear only a hospital gown (remove all underwear).
Your regular medications and premedication will be administered by the nurse. Premedication is given to alleviate stress that may be related to the surgery. (Do not take any medications on your own.)
When it is time for you to be taken to the operating room, a representative will come to escort you. The admission nurse of the operating room will confirm your details, ensure that all necessary preparations for the surgery have been made, provide you with guidance, and answer any questions you may have.
In the preoperative holding area, you will also meet the anesthesiologist, who will explain the purpose of the anesthesia and the type of anesthesia to be used and ask you to sign the anesthesia consent form.
An attending nurse from the surgical department will also guide you through the preparation for the surgery, the procedure itself, and the postoperative recovery.
After completing the preoperative process, you will be taken to the operating room. Family members can wait in the nearby waiting area until the surgery is completed. The surgeon will update them after the surgery.
Hospital Room:
The department has 52 beds. Each patient's unit includes a bed, a call bell to summon the nurse, a closet, a personal chair, a night lamp, a private bathroom, and a shower attached to the room.
Family members can stay with you 24 hours a day during your hospitalization.
After the surgery:
You will be transferred to the recovery unit adjacent to the operating room.
In the recovery unit, you will be under the supervision of a nurse who will monitor your blood pressure, heart rate, and breathing.
The surgical wound will be checked, and the output from the catheters will be monitored.
If you experience any pain or nausea, you can request pain relievers or anti-nausea medication.
You will remain in the recovery unit until the next morning. After that, when your condition allows and with the doctor's approval, you will be transferred to a regular ward.
When leaving the operating room, you will have:
- Fluids drained from the abdomen.
- Catheters placed to drain urine from the bladder.
- A Zonda (nasogastric tube) inserted through your nose to drain secretions from the upper digestive tract.
- WIZAIR device on your legs to encourage blood flow and prevent blood clots.
- There may also be a PCA (Patient Controlled Analgesia) pump to administer pain medication.
One family member can enter the recovery unit with the nurse's permission.
In the ward:
You will be hospitalized for about ten days to three weeks after the surgery.
In the ward, you will be attended to by a nurse who will monitor your condition and take blood tests as needed.
You will receive fluids through the IV and, at times, intravenous feeding.
Eating and drinking will be prohibited until your digestive system resumes functioning. The return to a regular diet will be gradual and very slow, only after the removal of the Zonda tube.
The catheters will be removed gradually under the surgeon's instruction.
Pain:
After the surgery, you may experience pain and discomfort. The pain level will be measured on a scale from 5 to 51.
You can receive pain relievers through the IV, injections, or orally when you start drinking and eating.
The medication dosage will be adjusted to ensure you are not in significant pain. If the pain persists, inform the nurse.
Additionally, there is an option for pain management through the Patient Controlled Analgesia (PCA) device, which allows you to control the pain relief. The PCA device is connected to the IV or epidural space in your spine, releasing pain medication regularly or by your pressing a button during pain. It's essential to know that the device is programmed to prevent administering excessive doses of pain medication, and you will be in control of the pain relief.
Mobility:
To avoid complications from prolonged lying, follow these guidelines:
- Get out of bed with the assistance of a nurse on the day after the surgery.
- Engage in walking.
- Spend extended periods out of bed.
- A physiotherapist will visit you the day after the surgery to provide guidance on breathing exercises to maintain proper lung function.
Bathing:
Every morning, you will receive assistance with bathing from a staff member of the department.
Nutrition:
You will receive dietary guidance from a dietitian before your discharge, tailored to your individual needs.
In the initial post-operative period, it is advisable to eat small, frequent meals, 4-9 times a day. Eat slowly and chew thoroughly.
Due to changes in your digestive system and the removal of a portion of the pancreas, which produces important enzymes for digestion, you may experience disturbances in digestion and nutrient absorption in the first few weeks after the surgery. This may manifest as fatty, pale stools. You may need pancreatic enzyme supplements.
In the first weeks after the surgery, most patients tend to lose weight. However, weight gain is expected within three months after the surgery.
Diabetes may develop as a result of removing a portion of the pancreas, and in that case, you will require tailored care for diabetes and insulin injections.
Homecare:
Inform the community doctor about the surgery you underwent.
Ensure maximum cleanliness of the surgical area through daily washing with soap and water.
Follow the post-operative care and monitoring instructions provided in the discharge letter.
In case of any redness, tenderness around the wound, purulent discharge, fever above 38°C, severe pain accompanied by nausea, vomiting, abdominal swelling, or constipation, seek medical assistance, contact the department, or go to the triage room.
Physical Activity:
You can gradually resume physical activities. It is recommended to avoid heavy physical work or sports activities until receiving approval from the surgeon.
Treatment of the Surgical Wound:
Bathe every day and rinse the wound with soap and water. Dry thoroughly. There is no need for dressing or ointment.
Important to Note:
If you experience any redness, tenderness, purulent discharge, fever above 38°C, severe pain accompanied by nausea, vomiting, abdominal swelling, or constipation, seek medical assistance, contact the department, or go to the triage room.
Social Services:
Hospitalization due to illness and/or surgery can lead to moments of crisis and difficulties that require assessment and support. Patients and their families can access a social worker in the department who provides guidance, support, information, and assistance with exercising rights, planning hospitalization and discharge, and referring to community services. You can contact the social worker through the department nurse.
Upon Discharge:
You will receive a discharge letter with recommendations for continued treatment in the community, along with a scheduled date for follow-up in the surgical clinic for examination, monitoring, and suture/staple removal.
You can make an appointment by calling the appointments center at 02-6555999.
Bring the commitment from your health fund and the discharge letter to the clinic.
How to Handle at Home:
Inform the community doctor about the surgery you underwent.
Maintain maximum cleanliness of the surgical area through daily washing with soap and water.
Adhere to the post-operative care and monitoring instructions in the discharge letter.
If you experience pain, you can take pain relievers as directed by the doctor.
Treatment of the Surgical Wound:
Bathe every day and rinse the wound with soap and water. Dry thoroughly. There is no need for dressing or ointment.
Important to Note:
If you experience any redness, tenderness, purulent discharge, fever above 38°C, severe pain accompanied by nausea, vomiting, abdominal swelling, or constipation, seek medical assistance, contact the department, or go to the triage room.
Physical Activity:
You can gradually resume physical activities. It is recommended to avoid heavy physical work or sports activities until receiving approval from the surgeon.
Nutrition:
You will receive dietary guidance from a dietitian, tailored to your individual needs, before your discharge.
In the first few weeks after the surgery, it is advisable to eat small, frequent meals, 4-9 times a day. Eat slowly and chew thoroughly.
Due to changes in your digestive system and the removal of a portion of the pancreas, which produces important enzymes for digestion, you may experience disturbances in digestion and nutrient absorption in the first few weeks after the surgery. This may manifest as fatty, pale stools. You may need pancreatic enzyme supplements.
In the first weeks after the surgery, most patients tend to lose weight. However, weight gain is expected within three months after the surgery.
Diabetes may develop as a result of removing a portion of the pancreas, and in that case, you will require tailored care for diabetes and insulin injections.
For any questions or concerns, you can consult the general surgery department's team at any time during the week.
Call: 02-6555769, 02-6555569
Wishing you a speedy recovery,
Pre-operative care team
and the General Surgery Department.