Post-Operative Recovery

The length of hospitalization depends on the specific procedure that was performed and the approach that was undertaken (traditional versus minimally invasive), but most patients will be in the hospital for anywhere from 3 days (minimally invasive distal pancreatectomy) to 10 days (Whipple). Once home, the full recovery is expected to take 6 to 8 weeks.  Your body has to work hard to recover from the operation, and many patients will feel fatigued.  During this period of time, patients struggle the most with eating.  After pancreatic surgery, patients can expect to have a reduced appetite and fill up quickly when eating.  Many patients are not hungry and experience symptoms of nausea and bloating.  Although the early postoperative period can be challenging, most patients will experience marked improvement in these symptoms by 2 months after the operation.

When recovering from a pancreatic operation, patients do best when they the goal eat small, frequent meals/snacks every three hours. In general fat should be avoided and protein-containing foods are the best.  In the early postoperative period, the most important thing is to stay well hydrated.  Many patients benefit from working with our clinical nutritionist throughout their course of their disease, especially when recovering from surgery.

Nutritional support

Patients with pancreatic or gastrointestinal disease often encounter problems with their eating or maintaining weight. A clinical nutritionist is a vital member of the team of providers in the management of pancreatic cancer.  The nutritionist will assess your individual needs and develop an eating plan that suits you.

Postoperative Dietary Expectations

Whipple:

When patients wake up from the surgery there will be a (temporary) drain in the stomach that comes out of the abdomen through the abdominal wall.  This is called a gastrostomy or G-tube.  It will be hooked up to a bag to continuously drain the stomach.  For the first one to two days following the surgery, the tube will be left open to drain into the bag.  During this initial period, patients are encouraged to drink anything that you can c see light through (clear liquid diet).  During this initial phase, the stomach is being rested by the drainage.  On or around postoperative day 2, the surgical team will ask the patient not to eat or drink anything and the nurse will clamp the gastrostomy tube for intervals of 6 hours.  After 6 hours, the clamp will be removed and the nurse will measure the amount of residual fluid in the stomach.  The stomach itself secretes about one to two liters (one to two quarts) of fluid a day.  So, if the stomach is emptying, then the residuals should be low (less than 300 cc) after a 6 hour clamp.  Once a low residual is seen, the tube will be clamped for a full 24 hours.  If the residual remains low after the 24 hours of clamping, then the tube is kept clamped and the patient’s diet is advanced, first with liquids and then with solid food as tolerated.

Most patients are tolerated solid food by about a week after the surgery.  Waiting for the stomach to function is typically what keeps most patients in the hospital the longest.  Once home, patients do the best by eating small frequent meals through out the day.

Distal pancreatecomy

Most patients are not hungry and will have some nausea and abdominal bloating in the early postoperative period.  Patients undergoing this operation are typically offered a clear liquid diet on the second day after surgery and advanced to solid food as tolerated.  The tail of the pancreas lie directly behind the stomach and the trauma from the surgical procedure will result in inflammation along the back of the stomach where the removed portion of the pancreas had been.  This inflammation will cause temporary stomach dysfunction for a period of time in most patients.  As the inflammation subsides, the stomach will begin to function properly again.  This process can take a little as a few days or as much as several weeks in a patient who has leakage of pancreatic enzymes after the surgery.