Enhanced Recovery (ERAS) in Liver SurgeryDeesa Ward and Julie Jeffery

The ‘Enhanced Recovery Programme’ is about getting patients fi t before surgery and safely speeding up the recovery time, as well as reducing the incidence of complications.In order for the programme to succeed, patients have to actively participate in their own recovery by taking responsibility for certain aspects of their care and recovery.

Getting better quicker, safer!

The main focuses of the programme are: Prehabilitation & patient education Reducing the physical stress of the operation Structured approach to post-operative management Early mobilisation Early feeding Setting daily goals

We have a specialist team of surgeons, anaesthetists, clinical nurse specialists, dieticians, physiotherapists, nurses and clinical support workers, who work collaboratively to ensure the best care is given.

After implementation of the ERAS programme, so far we have safely managed to:

Decrease in overall length of stay by:

28%

Decrease length of stay for patients over 70 by:

35%Decrease post-operative complications by:

29%

Poster produced by Medical Illustration Services, The Leeds Teaching Hospitals NHS Trust. Ref: 20160816_004/MH

The ERAS team are here to help you through your treatment. Please feel free to contact us on: Telephone: 0113 206 8878 or email: deesa.ward@nhs.net

Early oralnutrition

Avoidopioids

Early removalof catheters

General/Localanaesthetic

Early mobilisation

Avoid fluidoverload

Smallincision

Preventhypothermia

Avoidsdrains

Early ambulance

No bowelprep

ManagePONV

No NGT

NSAIDS

CHO loading

No pre-med

EnhancedRecovery

The Leeds Teaching HospitalsNHS Trust

n

Liver ResectionEnhanced Recovery Programme

Information for patients

2

This booklet has been produced to provide information for patients undergoing liver resections on the Enhanced Recovery Programme. It is intended to add to the discussions that you will have with your consultant and other team members

IntroductionWe realise this is an anxious time for you and your relatives. We hope that by providing accurate information you will know what to expect before and after your operation and hopefully feel better prepared. St James’s Hospital is a regional centre for liver surgery, specialising in many different types of liver resection. This is a complex and major operation to remove part of your liver and is carried out for patients who have a tumour in their liver. These tumours can be either primary cancers, which originate in the liver or secondary cancers which originate elsewhere in the body, but usually in the large intestine.

Surgery may also be performed for some benign conditions of the liver.

3

The LiverThe liver is the engine house of the body

It weighs 2% of your total body weight

It is a common site for bowel cancer secondaries

You can survive with up to 65-75%of your liver removed

After your operation your liver will regrow to its normal size

7

8

4 3

1

2

5

6

Left Lateral Right Hemihepatectomy Sectionectomy = 2 3 = 5 6 7 8

Left Right Trisectionectomy Hemihepatectomy = 1 2 3 4 = 4 5 6 7 8

Left Trisectionectomy = 1 2 3 4 5 8

5

Enhanced Recovery ProgrammeAs part of your surgery you will be placed on an Enhanced Recovery Programme.

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 are and recovery. This will be indicated in your ‘Enhanced Recovery Diary’.

The Leeds Teaching HospitalsNHS Trust

n

Enhanced Recovery Diary for Liver Surgery

Information for patients

Please watch the ‘Enhanced Recovery’ video on YouTube for more information on the programme. Search ‘ERAS Liver Leeds’