Laparoscopic donor nephrectomy discharge information

This leaflet has been written to answer questions that you, as a living kidney donor, may have about what you should or should not do after your operation. If you have further questions after reading this information, please speak to your surgeon, ward nurse or living donor coordinator.

What happens after the operation?

You may feel nauseated for 24 hours following the operation but medication can be given to control this.

In hospital you will be encouraged to sit out of bed and move about from the day after the operation. It is important that you should walk short distances the day after the operation. You may be discharged from the hospital at anytime from the day after the operation depending on your clinical condition.

• Following the operation it is usual to have some shoulder or stomach pain for a couple of days. This pain is often described as a “wind-like” pain, and is due to the surgeon using gas to inflate your abdominal cavity so that he can see the kidney better. Most patients only need mild painkillers, but as in any surgery, there may be more discomfort requiring stronger painkillers.
• Many patients find a degree of difficulty in opening the bowels for the first time after the operation. If necessary you may be given suppositories or a laxative to help you.
• The small wounds are normally closed with dissolvable stitches, and should not need any attention other than keeping them clean. There may sometimes be a little oozing from one or more of the wounds, in which case they can be covered with a sterile dressing until this stops. You can bath or shower as normal.
• You may eat and drink normally as soon as you feel able. There is no need to change your diet or fluid intake.
• During your hospital stay you will be given a daily blood thinning injection (Dalteparin) into your lower abdomen in order to prevent deep vein thrombosis (dangerous blood clots in the leg). This starts the day before your operation and will need to be continued for two weeks afterwards. You will be taught how to do this. If you or your family are unable to do this, it may be possible to get it done daily at your GP surgery
• When the urinary catheter is removed and you are passing urine satisfactorily and you are able to move about comfortably, you may be discharged home.

What happens when I go home?

Before going home you will be given an appointment to return to the clinic for a check-up four to six weeks after the operation. You will be given painkillers to take home and a note for your GP listing your treatment and medicines. You will also be given a supply of the blood thinning injections (Dalteparin)

What should I do when I get home?

• It is sensible to avoid heavy lifting and driving for two to three weeks after the operation, since any sudden increase in abdominal pressure can cause pain in the wounds. Exercise should be increased gradually. Start with short walks and gentle exercise.
• Eat a healthy diet with plenty of fluids. Fresh fruit and vegetables are important to keep your bowels regular as your bowel can be ’lazy’ for several days after the operation.
• Chest infections and constipation are relatively common immediately after the operation but exercise and laxatives will help your body to settle down.
• You can return to work when you feel fit. Usually three to six weeks off work are needed though this will depend on your job. Sexual intercourse can be resumed three to four weeks after the operation.
• After any surgery you may feel tired and rather emotional for a number of weeks. This is quite normal, but if you feel depressed it is important to tell your GP.

What should I look out for?

Serious problems after this operation are relatively rare, but you should be aware of the following points:

• Any operation inside the tummy (abdomen) will cause scar tissue and internal adhesions within the tummy (abdomen), which normally do not cause any problems. Very occasionally this may result in chronic abdominal pain or obstruction (a blockage), which might require surgery.
• Surgical wounds can become infected and not heal as quickly as normal.
• Any surgical wound in the tummy (abdomen) may increase the slight risk (two to five per cent) of developing a hernia, but if this occurs it can be repaired.
• Patients who donate one kidney during their life have been shown to have an increased tendency to lose a small amount of protein in their urine and have an increased chance of developing high blood pressure later in life. The implications of these tendencies are not fully known. Therefore it is important that you have a regular check up each year to have your blood pressure checked and treated if necessary.
• Occasionally other complications that can occur infrequently include long term wound pain, urinary infection, swelling of testicles, drug/dressing allergies, pneumothorax (collapsed lung), pleural effusion (fluid around the lungs), fluid collections in the abdomen requiring drainage, leak from the pancreas and leg paraesthesia (pins and needles or numbness in the leg).

If you feel unwell, or have any concerns following discharge, your GP can advise if you need to be seen at the hospital. You are also always welcome to telephone the living donor coordinators or the transplant ward for advice.

For all donors, arrangements will be made for you to have yearly checks of your kidney function and blood pressure, either at Addenbrooke’s, your local hospital or GP. Please remember to let us know if you change your address or GP.

Drugs to avoid in the future

Some pain killers, which belong to a group of drugs called NSAIDs (non-steroidal anti-inflammatory drugs) may be harmful to renal function with prolonged use. After your nephrectomy it is recommended that you avoid these drugs and seek an alternative form of pain relief in the future. Your GP will be able to advise you.

Drugs to avoid include some that are taken by mouth, for example

Ibuprofen (Brufen®, Arthrofen®, Ebufac®, Rifafen®, Alprefen®, Feverfen®, Nurofen®, Orbifen®, Fenfid®)

Diclofenac (Voltarol®, Voltarol rapid®)

Naproxen (Arthroxen®, Naprosyn®, Synflex®)

and some that can be applied to the skin, for example

Ibuprofen gel (Fenbid®, Ibugel®)

Ketoprofen gel (Oravail®, Powergel®)

Piroxicam gel (Feldene®)

Diclofenac gel (Mobigel®, Pennsaid®, Voltarol®)

Felbinac gel or foam (Traxam®)

Who can I call if I have any questions?

Ward G5 (transplant ward) 01223 217711

Living kidney donor coordinators 01223 596177 or 256760 or 586979 (office hours only)