Hepatobiliary Surgery - Leeds Teaching Hospitals NHS Trust

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:

ERAS in Liver Surgery at The Leeds HPB & Transplant Centre

Hello, my name is Raj Prasad, and I’m one of the liver surgeons here in Leeds. Welcome to this video on the Enhanced Recovery Program, which explains the key principles behind it. You might have heard about this program when discussing your upcoming liver surgery with your doctors and nurses.
Enhanced recovery begins before you come into the hospital, and by watching this video, you’ll understand the principles and what to expect when you come to St James’s University Hospital for your liver surgery.

The main principle of enhanced recovery is to empower you to take control of your own recovery. This approach helps you recover faster, more safely, and more effectively than standard care. The core aspects of enhanced recovery include mobilizing earlier, eating and drinking sooner, and using advanced pain relief techniques. These innovations help you get back on your feet more quickly.
In the following segments, we’ll go into more detail about the program’s principles. I hope you’ll feel confident to implement these strategies when you come in for your surgery with us.

Pre-Surgery Planning
Once a decision is made to proceed with your surgery, you’ll visit the Surgical Outpatient Department, where you’ll meet with a surgeon to discuss your options. At this stage, we’ll inform you that you will be part of the Enhanced Recovery Program. You will also be invited to attend a Patient Recovery Education Program (PREP) session, where we’ll guide you on how to prepare for both the surgery and your recovery.

As part of your treatment, you’ll need to attend a pre-operative assessment. This appointment includes a health check to ensure you’re fit for surgery and anesthesia. We’ll check your blood pressure, take blood samples, perform an ECG if needed, and carry out MRSA screening.

As you’re now part of the Enhanced Recovery Program, we’ll provide you with six small bottles of a pre-op drink. You’ll be asked to drink four of them the evening before surgery and then fast on the morning of your operation. When you’re admitted to the hospital, you’ll take the remaining two bottles.

Please bring your overnight essentials, medications, and the Enhanced Recovery Patient Diary with you when you come to the hospital.

On the Day of Surgery
When you arrive at the Same Day Admissions Unit on the morning of your surgery, we’ll ensure you have followed the pre-op instructions and that you’ve taken all your drinks as required. A key part of the Enhanced Recovery Program is warming you before surgery. About an hour before your operation, you’ll wear a warming gown to help maintain your body temperature and ensure you’re comfortable.

During Surgery and Recovery
The Enhanced Recovery Program uses advanced techniques in anesthesia and surgery that promote better outcomes. Evidence shows that patients who follow this approach tend to experience fewer complications and recover faster.
Moving after surgery plays an important role in your recovery. If it’s safe and you feel well enough, our physiotherapy and nursing teams will assist you in getting out of bed and taking a short walk on the first day after your surgery. Don’t worry about drips or drains—we’ll help you manage them. Once you’re able, we’ll encourage you to walk more regularly, and keeping track of your progress in your diary will help you stay motivated.

Pain Management
After major abdominal surgery, it’s normal to experience some pain. To manage this, you may have an epidural, a wound catheter infusion, or a patient-controlled analgesia (PCA) system. A team of pain specialist nurses will ensure you’re getting enough pain relief so that you can move, breathe, and cough comfortably while recovering.

You’ll also be guided to do daily breathing and leg exercises to prevent complications like chest infections and deep vein thrombosis (DVT). We’ll show you how to use an incentive spirometer to help expand your lungs and prevent chest infections, and remind you daily to do your leg exercises.

Preparing for Discharge
Around the third or fourth day after your surgery, we’ll begin planning for your discharge. You won’t be discharged until the doctors are sure you’re fit to go home. We aim to ensure that you leave the hospital safely, and we’ll arrange follow-up phone calls to check on how you’re managing at home.

Your Role in Recovery
A central aspect of the Enhanced Recovery Program is your involvement in your own recovery. From now on, think of it as my recovery. If you follow the principles outlined in this video, we can help you recover more quickly and safely.

For more information about the Enhanced Recovery Program, please get in touch with us.

Contact us

For further information regarding the Enhanced Recovery Programme (ERAS) please contact:

Deesa Ward Enhanced Recovery Clinical Nurse Specialist

Telephone: 0113 206 8878

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

A copy of the ‘ERAS – Liver Resection’ booklet can be found in the resources section

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.

When to take the Pre-Op carbohydrate drinks:

Between 6:00pm and 10:00pm the night before surgery: Drink 4 bottles of Pre-Op carbohydrate drink
6:00am on the morning of surgery: Drink 2 bottles of Pre-Op carbohydrate drink

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.