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Peritoneal based Malignancies

Peritoneal based Malignancies - How to prevent?

Peritoneal based Malignancies - Post-surgery care

The surgery may last from 4-12 hours or even longer.  The duration of surgery depends on the extent of adhesions from prior surgeries, the extent of peritoneum being removed and the number of other organs requiring excision. Afterwards you will be nursed in our surgical intensive care unit (SICU) or a high-dependency unit (HDU), and discharged to the general ward when stable. The average total hospital stay is 10 days.

When you first wake up from anaesthesia, you may still have a tube in your throat to assist with your breathing. You will notice intravenous lines in place in your arms and neck. These are necessary for fluid replacement, pain medication and nutrition. A nasogastric (NG) tube inserted through your nose into the stomach for draining out the abdominal fluid. You may also have 2 to 4 abdominal catheters for drainage. During the surgery, chest tubes may be inserted, and a urinary catheter will also have been placed to assist us in monitoring your urine output.

Pain medications are usually administered via an intravenous line. It may be a continuous infusion or you may have a pump for Patient Controlled Analgesia (PCA). With a PCA, the painkillers will be given as required when you push a button for the medication.

The majority of patients stay in the SICU for one day before being transferred to the HDU. Your care will be coordinated by an intensive care physician and your surgeon.

Stomas
Some patients who undergo this operation will need a temporary stoma. This will be reversed after about 2 months, on discussion with your surgeon and medical oncologist. All patients will be seen by our specialist stoma nurse before and after the operation, who will give you more information about looking after a stoma.


Recovery
After your chemotherapy is completed, the chest tube is removed. The abdominal drains are removed once the output diminishes and the contents are clear. The urinary catheter will be removed at the discretion of your surgeon.

The NG tube will remain until your bowel function returns and you are able to drink. Your oral intake will be progressed from fluids to foods as decided by your surgeon.

To prevent blood clots in the leg that may travel to the lungs and cause a blockage, compression devices will be applied to your legs. This will be applied just before surgery and left on until you start walking. These may be tight and uncomfortable but are necessary to encourage blood circulation. An injection may also be given to you daily to prevent blood clots.

To prevent lung infections, your physiotherapist will work with you on deep breathing exercises. They will also supply you with a device (incentive spirometer) which you can use to continue to do the breathing exercises regularly.

Pain medication will be continued intravenously until you are able to take painkillers orally. The aim is for you to have minimal discomfort.

By the 2nd to 3rd day after surgery, we will encourage you to increase your activity.  We will begin by helping you to sit out of your bed on a chair before we progress to helping you walk with assistance then independently.

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