Before your operation for bile duct cancer
You have a pre assessment appointment and some tests before your operation. This is to make sure you are well enough for surgery and that you know how to prepare for it. You will also meet members of your healthcare team.
Pre assessment
Your pre assessment appointment prepares you for your operation. This usually happens in the 2 weeks before your surgery.
At your appointment the pre assessment team may:
- ask you questions about your health and any medicines you are taking
- tell you when to stop eating and drinking before your operation
- tell you if you need to stop taking any medicines before the operation
- check your weight, blood pressure, pulse and temperature
- ask what help and support you have at home
The pre assessment team will tell you how to prepare for your operation. What you need to do depends on what operation you are having.
They may also give you a leaflet about breathing and leg exercises to do after your operation. This is to help prevent chest infections and blood clots.
It helps to write down any questions you have and take them with you. The more you know about what is going to happen, the less frightening it will seem. You can ask more questions when you go into hospital so don’t worry if you forget to ask some.
Enhanced Recovery After Surgery (ERAS) Programme
The pre assessment team might tell you about the Enhanced Recovery After Surgery (ERAS) Programme. This is for people having a big operation and is to help you recover quicker. It starts before you have your operation and continues for a short time after you have gone home.
For example, they might give you carbohydrate drinks to have before your operation. How many drinks you have depends on what brand of drink the hospital uses. And when you have them depends on what time of day your operation is.
After your operation your nurses will encourage you to do breathing exercises. They will help you with getting out of bed and walking as soon as you can. And start you eating and drinking as soon as possible. This depends on the type of operation you’ve had. But your doctor will tell you when you are ready to do this.
Prehabilitation
Some people might also be asked to take part in prehabilitation (prehab). Prehabilitation means getting ready for cancer treatment in whatever time you have before it starts. It is a programme of support and advice that some NHS hospitals are using. It covers three particular parts of your health:
- what you're eating and your weight
- physical activity or exercise
- mental wellbeing
Not all hospitals have a prehabilitation programme. Sometimes the programme is run at local leisure centres. You will be told where you need to go.
Who you might meet before your operation
Nurse or healthcare assistant
At the pre assessment clinic a nurse or health care assistant checks your:
- general health
- weight
- blood pressure
- pulse
- temperature
The nurse asks you questions to check your fitness for the operation. They can organise any further tests you might need. They ask about any medicines you are taking and give you information about what to expect when you come into hospital for the operation.
Specialist nurses
You may also see your specialist cancer nurse. They can help answer any questions you have about the operation. And they can check what help and support you have. This is to see if you will need an extra help when you go home. They are usually your main point of contact, and care for you throughout your treatment.
The anaesthetist
The anaesthetist gives you the anaesthetic and looks after you during the operation. They make sure you’re fit enough for the surgery.
The surgeon
A member of the surgical team will tell you about:
- the operation you are going to have
- the benefits of having surgery
- the possible risks
- what to expect afterwards
You can ask them any questions you have. Then they will ask you to sign a consent form to say you agree to the surgery.
The dietitian
The dietitian gives you help and advice about managing your diet. They:
- help you get as well as possible before your operation
- explain how the surgery affects your diet
- give useful tips on how to increase your nutrients and calories
They might give you nutritional supplement drinks to have before surgery.
The physiotherapist
The physiotherapist assesses how well you can move around. They let the doctors know if there is anything that could affect your recovery.
The physios or nurses also teach you leg and breathing exercises to do after your operation to help with recovery. Learning how to do the exercises beforehand makes it easier afterwards.
Learning breathing and leg exercises
Breathing exercises help to stop you from getting a chest infection after surgery. If you smoke, it helps if you can stop at least a few weeks before your operation.
Leg exercises help to stop blood clots forming in your legs. You might also have medicines to stop the blood from clotting. You have them as small injections under the skin.
You start the injections after your operation. You might also wear compression stockings and pumps on your calves or feet to help the circulation.
Your nurse and physiotherapist will get you up out of bed quite quickly after your surgery. This is to help prevent chest infections and blood clots forming.
This 3-minute video shows you how to do the breathing and leg exercises.
Breathing and circulation exercises after surgery
These exercises help prevent you developing a chest infection or blood clots in your legs after surgery. These problems are more likely when you are not moving around as you would normally.
You can do these breathing exercises while sitting up in a chair or in a bed or whilst lying down.
Relax your shoulders and upper chest.
Take a slow, deep, comfortable breath in and hold for a couple of seconds, then slowly breathe out.
Repeat this 3 times.
You can start these breathing exercises as soon as you come round from your anaesthetic.
You should try to do them every hour when awake until you are fully mobile.
If you need to cough, support your wound with your arms, a pillow or a rolled up towel.
If you are struggling to clear any phlegm, try a huff. This is where you breathe out in a short, sharp manner as if you were trying to steam up a mirror.
You should move about as soon as possible after your operation. But while you are not as mobile, try to keep your legs moving to encourage better circulation.
You can do these exercises in a bed or in a chair.
One foot at a time point your toes away from you then pull your toes towards your chin.
Try to do 10 of these on both feet at least 2-3 times an hour.
The next exercise is circling your ankles. One at time circle your ankles, clockwise and then anticlockwise. Repeat this 10 times with each ankle 2-3 times an hour.
Tests you might have
Before your surgery, you have tests to make sure you’re fit enough to make a good recovery. These may be arranged by your specialist or at your pre assessment appointment. They normally include:
- blood tests to check your general health and see how well your kidneys are working
- an
ECG 
(electrocardiogram) to check your heart is healthy
You may also have:
- a chest x-ray to check your lungs are healthy
- breathing tests (called lung function tests)
- a test that measures your ability to exercise (
cardio pulmonary exercise test ) - an ultrasound of your heart (
echocardiogram ) - tests to see how well your liver works
Getting ready to go into hospital
Before you go into hospital you might need to sort out a few things. This can include:
- work
- care for children or other loved ones
- care for your pets
- care of your house
- cancelling your milk, newspapers or food deliveries
What to take with you
The pre assessment nurse will suggest what to take with you when you go into hospital.
They may ask you to only bring a few essentials and ask that your relatives or friends bring the rest when they visit you. If this will not be possible let the pre assessment nurse know.
Some examples of what to take are:
- your medicines
- nightgowns or pyjamas
- underwear
- dressing gown
- slippers
- contact lenses, solution, glasses and a case
- wash bag with soap, a flannel or sponge, toothbrush and toothpaste
- sanitary wear or tampons
- razor
- towel
- small amount of money
- magazines, books, playing cards
- headphones and music to listen to
- your mobile or a tablet and charger
- a copy of your last clinic letter (if you have one)
Your admission time
You normally go into hospital on the morning on your operation. Sometimes you may go in the night before. This can depend on the hospital.
Make sure you know what time you should be at the hospital. And which department you need to go to. Call them if you are going to have problems getting to the hospital on time.
