HPB (Hepato-Pancreato-Biliary) Surgery is a specialty that deals with surgery of liver, bile ducts and pancreas.
This relates to both benign (such as pancreatitis) and malignant conditions (such as liver or pancreas cancer) of these organs. The HPB Team at Addenbrooke’s Hospital is the East of England’s Regional Referral Centre for all benign and malignant diseases of the pancreas, biliary system and cancer of the liver. Being one of the largest centre in the country, we perform on average 100 pancreatic and 150 liver resections in a year with excellent outcomes.
The HPB team also deals with surgery of the gall bladder for gall stones (Cholecystectomy) although this condition may also come under general or upper gastro-intestinal surgery. We are regional referral centre for complex gall bladder surgery and bile duct injuires.
Guidance for patients
As part of planned treatment such as surgery, you may have attended an outpatient clinic, where detailed information would have been given with regards to the treatment options available and risk and benefits of various approaches would have been explained. The generic information below may be useful in maintaining your health and preparing yourselves whilst you are waiting for surgery. If you have any specific queries about this advice or have any concerns if the guidance applies to you please do get in touch with us.
Side effects of cancer and its treatment may include weight loss, reduced appetite, nausea, increased blood glucose levels and changes in bowel habit. The following advice provides information about how to optimise your fitness and minimise loss of weight and muscle. This may help you to have more energy and feel better. Being better nourished may also help you to cope with treatment such as surgery.
Are you eating less than you usually would?
If you are eating less than you usually would, the following tips may help you have a little more.
- Eat “little and often”
- Be positive about what you do eat – every extra mouthful helps.
- Try not to get out of the habit of eating. You need to eat to stimulate your appetite.
- Make the most of the times you feel like eating. Even if it is at unusual times. Some people like to ‘breakfast like a king’, eating a larger than usual breakfast and then less later in the day when they are fuller and more tired.
- Experiment with different foods. You may find that you like things you don’t usually eat, particularly if your sense of taste has changed.
- Sometimes the smell of food will be appetising while at other times it may put you off. If this happens, try to keep away from the kitchen while food is being prepared, or eat cold foods, which often have less smell.
- Accept offers from friends and family to help with cooking and shopping.
- Convenience foods and ‘meals on wheels’ are a useful standby and can be just as nourishing.
- Try to reduce time sitting and lying down if you can, this will help to preserve your muscles and can also stimulate your appetite.
- Some people are put off by large portions an actually eat more with less on their plate.
- Some people prefer to have food given to them than be asked what they’d like to eat, as the talking about it before hand can be off putting.
Exercising before your surgery
Muscle loss is common in people who have prolonged illness such as cancer. Being unwell, eating less and being less active can all lead to loss of muscle bulk, strength and overall fitness. Doing regular exercise can help to minimise loss of muscle. Preserving your muscle will help you to have more energy, feel good and cope better with any treatment you might have.
It is, extremely important to maintain and then increase your exercise tolerance when able before your operation. This will help to minimise the risk of complications after the operation and will help your recovery time. All exercise, no matter how small or large, is beneficial.
The best activities use large muscle groups in a rhythmic manner: walking, aerobics, cycling, swimming, jogging, using machines such as climbers, stationary cycles, and skiing machines. Choose an activity that is convenient and fun for you.
Exercises that can be done easily at home; to strengthen muscles include:
- climbing stairs
- standing up and sitting down onto a chair (repeat 10–15 times, using your hands as little as possible so your legs do the work)
- lifting soup cans
- push-ups against the wall or, for example from a work surface
You should try to schedule your activities so you are doing something at least five days per week. Planning this into your daily schedule will help you continue it on a regular basis. There is no time of day that is best for exercise, it all depends on what works for you and when you will be able to do it regularly.
It is best to start slowly and increase gradually with a short duration of activity and gradually increase the time of each session. Start with a comfortable, lower level of intensity and gradually increase it as you get used to the exercise. People may have problems, such as injuries, when they do too much exercise too soon. Gradual progression will help prevent those problems.
A lack of exercise and immobility before your operation can lead to muscle wastage and increase tiredness. Staying physically active will help in relieving some of this tiredness and maintaining your muscle strength. The more exercise you are able to do will greatly aid your recovery and ability to return to normal activities after your operation.
The amount of exercise that you will be able to do may vary depending on how you are feeling day to day. Try to achieve 20 minutes of moderate intensity exercise every day. This level of exercise should make your heart beat faster and make you feel comfortably short of breath. If you are unable to reach the 20 minutes do not worry, all exercise remains beneficial.
If you are waiting for gall bladder removal due to gallstones, low fat diet may help to reduce the number or severity of painful flare-ups. Detailed advice in this regard could be accessed via the link below
What should I do if my health is deteriorating
In the current times, it is likely that you may wait for longer periods for your treatment. This is particularly relevant for treatment of benign conditions such as gall stones where the waiting period could be several months.
If you feel that your condition is deteriorating such as with excessive or worsening pain, features of infections such as fevers and shivering or other relevant features such as jaundice, you should seek medical help immediately.
If following your first appointment you are already on our list waiting to receive treatment under HPB surgery, we would encourage you to contact us directly via the contact details given below.
If you are still waiting to be seen in HPB surgery then contacting you GP is the best option who will then be able to guide you to the most appropriate care.
In case of emergency, you may need to attend your local Emergency Department.
(During working hours Monday-Friday)
HPB Consultant Surgeons
Mr Asif Jah, Mr Emmanuel Huguet, Ms Anita Balakrishnan Telephone: 01223 257074
Mr Raaj Praseedom, Mr Simon Harper, Mr Siong Liau Telephone: 01223 256040
Mr Paul Gibbs, Mr V Kosmoliaptsis Telephone: 01223 217026
HPB Clinical Nurse Specialist Team Lena Loia, Mignon Umahon, Catherine Burke, Telephone: 01223 256147
HPB Administrator Gail Scutt, Telephone: 01223 257103
Specialist Dietitians Laura McGeeney, Victoria Carter, Emily Button, Rhianydd Jones Telephone: 01223 216655