Care after Whipple/Biliary Reconstruction Or Klatskin Tumor Resection - Back

What to expect at home

• You may feel fatigued or tired. It is common to need more help than usual.
• You may have some incisional discomfort. You may also expect some redness and swelling, but it is not okay for it to be hot to touch and/or oozing drainage continuously. Your pain medication should help with this.
• You will have a feeding tube and a T-tube. You will be instructed on how to care for them.
• You are expected to have a decreased appetite and it may be difficult to tolerate food for a few days once you are at home. You will have medication to help with this.
• You are expected to have some nausea and possibly vomiting. You will have medication to help you deal with this.

Incisional care

• Check your incision site daily for signs of abnormal redness that is hot to touch, swelling, or pus-like drainage. Report these immediately to the office at 975-2253.
• Keep incision site clean and dry after shower and sponge baths.
• White tapes (Steri-strips) cover your incision; leave them in place, as they will fall off on their own. If ends of tape loosen and curl they can be trimmed with scissors. (You do not need to report the strips falling off to the office).
• You may shower without covering your incision 48 hours after surgery.
• No tub baths, do not soak incision in water, or put any creams or ointments over the incision.

Diet

• Your doctor will discuss your diet and fluid intake with you. Your diet should consist of 6 small meals each day.
• It will take time for your body to adjust and you may have occasional nausea or vomiting. This is an expected problem after this type surgery. If you were not given a medication like Reglan to help you through this, please call the office.
• Tube feeding may also be prescribed. The social worker will make the arrangements for feeding supplies and a pump to be delivered to your home.
• Limit drinks with caffeine (colas, teas, and coffee). Avoid alcohol (wine, beer, and liquor) as it cannot be properly digested at this time and you will be on pain medication.
• You may be prescribed Erythromycin or Reglan in order to help your stomach empty so you will have less nausea and vomiting. These drugs may not be listed on the bottle under these names so check with your pharmacy if you are unsure of why you are on a particular medication.

Activity

• Avoid strenuous exercise for 6 weeks.
• You may walk about as you wish, even climb stairs but do not over do it. Gradually increase your activity every day. Walking is good exercise.
• Do not lift more than 5-10lbs for 4 weeks or until your doctor says it is okay.
• Do not drive for the first few weeks and as long as you are taking pain medications as this may impair your ability to drive safely. Driving a car with an automatic shift may not seem too demanding, however, you may need to slam on the brakes or quickly turn the steering wheel, straining or tearing your incision. Talk with your doctor during your follow-up visit about when you can resume driving.
• If you are working, you may return to work when your doctor approves. You may request a work release at your clinic appointment.
• Generally, sexual relations can be resumed when you feel able. If you have a specific question, ask your doctor.
• Check with your doctor when you want to resume your exercise routine.

Medications

• Keep track of the number of pain pills you are taking in a day and how many are left. Narcotic medications, such as Tylox, Percocet and Oxycodone, require a new prescription to refill. You will need to call the office in advance so that a prescription can be mailed to you or one day in advance if you plan on picking up the prescription in person. These medications cannot be phoned in to a pharmacy.
• Some pain medications can cause stomach upset if taken on an empty stomach so try to schedule dosing with mealtime. If you are unable to eat, take the pain pill and your nausea medicine around the same time.
• Try to take your medicine on a schedule whether you feel pain or not so you do not become too uncomfortable.
• Pain medications and surgery can cause your bowels to slow down. One formed bowel movement at least every other day is desirable. Gradually reintroduce a well balanced diet including high fiber foods.
• To prevent constipation, you may take 100mg caps of Docusate Sodium twice daily until you have recovered from the surgery.
• If you become constipated, take 1-2 tablespoons of Milk of Magnesia at bedtime. If you have no results by the next morning, take two more tablespoons. Other stimulant types of laxatives should not be necessary. If you do not have a bowel movement within one day of your second dose, call the doctor.
• You will be prescribed Pancrease, at least 3 tablets before each meal. This is a pill that you will have to take indefinitely.
• If you are prescribed Reglan and/or Erythromycin, take these medicines for 4-6 weeks. If you are no longer having nausea, then you may stop taking them.
• If it is suggested that you take Prosure, please call 1-800-986-7528 for instructions on ordering.

Special instructions

• If you have a T-tube, keep the site cleaned by using Peroxide and Q-tips.
  If the peroxide is too irritating to the skin, use warm water and antibacterial soap with Q-tips or gently wash around each tube site with soap and water daily in the shower.
• You will have your T-tube for 4-6 weeks or longer as needed. Call your doctor or nurse if the stitches have become dislodged. You will be directed to go to the nearest Emergency Room for assistance.
• Your transhepatic biliary stents will need to be flushed twice a day with 10cc of sterile saline (home health will be ordered to assist you at home as necessary). Check your stent sutures each day. NOTIFY the doctor if the stent becomes dislodged or sutures have broken.

When to call the doctor

• If your incision becomes red, hot to touch, swollen, or has any bloody or pus-like drainage.
• If you have a fever of 101.5 or greater or if you have chills.
• If you have increased pain, unrelieved by your pain medications.
• If you have persistent nausea, vomiting, diarrhea, or no bowel movement for more than 2 days after discharged from hospital.
• If you develop any unusual signs or symptoms.
• If you have any questions or concerns.

Questions

• Call the doctor’s office Monday through Friday, 8am-5pm to reach the nurse (205) 975-2253.
• After hours, weekend and holidays, you may call the hospital's operator at (205) 934-3411 and have the GI surgery Resident on call paged.