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Date issued: June 2023

For review: June 2025

Ref: A-207/Surgery/FH/Whipple's surgery v7

PDF: Whipples final June 2023 v7.pdf[pdf] 324KB

About your Programme/ Diary

This leaflet is for patients having a Whipple procedure. This operation is performed for benign (non-cancerous) and malignant (cancerous) disease.

This programme/diary is intended to help prepare and support you and your family/carers for your stay in hospital.  It outlines what should happen on each day.  Sometimes there will be a specific reason why something isn’t done but the team should explain this to you.  If you have any concerns about what has or has not happened on any day, please let a member of the team know.

The diary advises on what you can do each day to help your recovery after surgery and get you home as soon as it is clinically safe. It is a good idea to start planning for when you go home before you come into hospital, so that your discharge is not unnecessarily delayed.

Day of Operation (Day 0)

Before coming to hospital

On the morning of surgery, you must drink water until-

07:00 am if you are coming into hospital at 07:00 am

or

11:00 am if you are coming into hospital at 11:00 am.

You may be given water to drink whilst you are waiting in the hospital depending on the time of your operation.

Coming into Hospital

Please go to the Admission Ward as advised on your admission letter. You will be checked in by a nurse and seen by members of the surgical and anaesthetic team before you are taken to theatre for your operation.

After your operation

After your operation you might go to the Intensive Care Unit (Penrose or Pencarrow ward). You will normally stay on this ward for at least 24 hours before going to a surgical ward.

Drips, Drains and Tubes

After your operation you will have several drips, drains and tubes in place:

An intravenous (IV) drip is used to give you fluids until you are able to drink normally.

A naso-gastric (NG) tube is a fine tube that passes down your nose into your stomach and allows any fluids to be removed so that you don’t feel sick. This helps the area of the operation to recover.  The nurses might spigot the NG tube which means that a bung is put in it. 

A Intrapleural catheter/ Pain Controlled Analgesia (PCA)/ Rectus sheath catheter are fine tubes that deliver pain medication.

An abdominal drain a tube inserted near your abdominal (tummy) wound to help drain off leaking fluid from the joins created as part of the  Whipple operation.  

A urinary catheter is a tube (catheter) put into the bladder to drain your urine into a collecting bag

Reducing the risk of developing deep vein thrombosis (DVT-blood clots) – DVT Prophylaxis

You will be given a daily injection of a blood thinning medicine (Clexane) which you will need to carry on using for 28 days once discharged from hospital. This aims to reduce the risk of blood clots forming in your legs or lungs.

Pain Control

It is important that your pain is well controlled so that you can

• walk about

• breathe deeply

• eat, drink and sleep well

• recover more quickly

If at any time you feel your pain is not well controlled, it is important that you tell a member of the team. 

On the first few days after the operation, your pain will be controlled by an Intrapleural catheter/ PCA/ Rectus sheath catheter. You will also be given regular paracetamol through a drip. Once the Intrapleural catheters/ PCA/ Rectus sheath catheters are stopped, your pain will be controlled by medicine in liquid or tablet form.

Sickness

If you feel sick (nausea) let the doctors or nurses know as there are medicines which can help.

Exercise

Moving around as soon as possible after your operation will reduce your risk of developing a chest infection and blood clots and will help you recover from your operation more quickly. 

• In bed keep the backrest raised at a slight angle

• Every hour you should do some gentle breathing and leg exercises as follows:

  • Cough 2 to 3 times

  • Take 2 to 3 slow deep breaths to help keep your lungs clear

  • Flex your ankles by pointing your toes up towards the ceiling and then down towards the floor, then circle your feet in one direction and then the other

• The nurses will assist you to get out of bed and sit in a chair. Try to sit out in the chair for short periods in the morning and afternoon. Each day you should aim to spend longer periods of time in a chair than the previous day

• The nurses will assist you to gradually start walking. Build up the distance and time spent walking each day

• As well as building up your level of activity every day, you also need to have proper rest periods

Eating and Drinking

You will be encouraged to start drinking sips of water as soon as you feel able after your operation. 

From the second day after your operation, you can drink normally on the third day after your operation you will be able to start eating. Initially you might prefer to eat little and often. You will already be under the care of a dietitian. They will guide you and provide supplement drinks if required.

You may find that your sense of taste is altered, and your appetite is less than normal after your operation.  It can take several weeks for taste to return to normal. 

It is important to eat and drink as your body needs fuel to repair. 

CREON

As you are having part of your pancreas removed your body may be unable to digest food normally because you cannot make enough digestive enzymes. To replace these enzymes you will always need to take a medicine called CREON with everything you eat - snacks and meals (lifelong).  The team will give you more information about CREON and how to use it.

Personal Care

The nursing team will help you to wash yourself until you can manage on your own. 

Try to wear your day clothes in hospital as this can help you stay more active and be positive about your recovery. 

Review

• A member of the surgical team will see you at least once a day.

• If you or your family/carers need additional support or would like to talk to the Cancer Nurse Specialists, or the Surgeons please speak to a member of the team.

Daily Care ( see page 3 for explanation of words )

The next pages outline the routine for each day and include things that you should do to improve your post-surgery recovery.

Sometimes there will be a specific reason why something isn’t done but the team should explain this to you.

Day of operation (Day 0) and First day after operation (Day 1)

Monitoring:

Your blood pressure, temperature, pulse and breathing will be checked at least hourly on Day 0 and 2-4 hourly on Day 1

You will have a heart monitor attached (removed on Day 1)

You’ll have blood and blood sugar tests.

Pain Control:

You will have an Intrapleural catheter/ PCA/ Rectus sheath catheter in place and will be given paracetamol through a drip until Day 3.

DVT Prophylaxis:

You will have a blood thinning injection (in the early evening) every day while in hospital and for 28 days once home.

Drips, Drains and Tubes:

Oxygen will be given through a mask (stopped on Day 1)

1 abdominal drain will be in place

A urinary catheter will be in place

A naso-gastric (NG) tube will be in place

You’ll have fluids through an intravenous (IV) drip in your neck (this will be removed on Day 1) and arm.

Wound Care:

Your dressing will be changed if it is wet on Day 1 and replaced. If the dressing is dry the dressing will be removed.

Drinking:

You can have sips of water as soon as you would like.

Exercise:

Keep your backrest raised at a slight angle when in bed.

Do your deep breathing and leg exercises in bed.

You’ll be assisted to sit in a chair in the morning and afternoon on Day 1 and to start walking.

Second day after operation (Day 2)

Monitoring:

From Day 2 onwards your blood pressure, temperature, pulse and breathing will be checked every 4-6 hours.

Drips, Drains and Tubes:

A urinary catheter will be in place.

You will have an IV drip.

Drinking:

You can now start drinking normally.

Wound Care:

If your wound is dry, the wound dressing will be removed.

Exercise:

You should now be able to sit in the chair for longer periods of the day, aim for 8 hours out of bed.

You should be aiming to walk at least 4 times a day.

When in bed do your deep breathing and gentle leg exercises and keep the backrest raised at a slight angle.

Dressing:

You should try to wash yourself and dress in your normal day clothes if possible.

Third day after operation (Day 3)

Pain Control:

Your Intrapleural catheter/ PCA/ Rectus sheath catheter will be removed.

You will be given medicine in the form of tablets / medicine to manage your pain.

Drips, Drains and Tubes:

Your NG tube will be removed.

Your abdominal drains will be removed (unless there are concerns).

Your IV fluid drip will be removed.

You will have blood tests.

Your urinary catheter will be removed (unless there are concerns).

Drinking and Eating:

Continue to drink normally.

Exercise:

Aim to sit in the chair rather than using the bed during the day. Try to walk further and more often than yesterday. 

Fourth day after operation to leaving hospital

(Day 4 onwards)

You can now eat and drink normally. At first, you might find it easier to eat little and often.  You will need to take Creon tablets with all food (CREON 100,000 with meals and CREON 50,000 with snacks).

All your drips, drains and tubes should now be removed.

Your tablets / medicine should be controlling any pain.

You should continue to help your recovery and reduce the risk of developing a post operation complication by eating and drinking, sitting in a chair for most of the day and walking further than you did the day before.

You will be discharged from hospital when

• Your blood pressure, temperature, pulse and breathing are all stable.

• Your test results are within acceptable levels.

• Your wounds are healing well.

• Your pain is well managed.

• You are able to walk.

• You have someone to support you at home.

• None of the team has concerns about your fitness.

When you go home

Check with the nurse if you are going to be seen by a practice or district nurse.  If you had this operation to treat cancer, the Cancer Nurse Specialist will ring you, normally within 7 days of discharge, to check on you and your recovery.

Surgical Follow Up Appointment

Once discharged you will receive an outpatient appointment.  This appointment should be 4-6 weeks from the date you were discharged.  If you don’t receive an appointment please ring the consultant secretary on 01752 432150.

If you have any concerns or problems, please ring:

Stonehouse Ward                                         01752 431488

Wolf Ward                                                     01752 439677

Cancer Nurse Specialists                              01752 431527

Derriford Hospital Switchboard:                     01752 202082