From the Guidelines
Post colectomy management should prioritize enhanced recovery after surgery (ERAS) principles, including preoperative counseling, optimization of comorbidities, and multimodal pain control, as recommended by the most recent study 1.
Key Components of Post Colectomy Management
- Preoperative preparation: Patients should receive dedicated preoperative counseling, and optimization of comorbidities such as anaemia or diabetes should be performed before surgery, as suggested by 1 and 1.
- Pain management: Multimodal pain control, including regional anesthesia and non-opioid analgesics, should be used to minimize opioid use and promote early mobilization, as recommended by 1 and 1.
- Early mobilization: Patients should be encouraged to mobilize early, starting with sitting at the edge of the bed on postoperative day 1 and progressing to walking in the hallway, to reduce the risk of complications and promote recovery, as suggested by 1 and 1.
- Nutrition: Patients should be screened for nutritional status, and those at risk of under-nutrition should receive active nutritional support, including oral nutritional supplements (ONS) if necessary, as recommended by 1.
- Thromboprophylaxis: Patients should receive thromboprophylaxis with low-molecular-weight heparin, and this should be extended after discharge in patients with relevant risk factors, such as previous VTE history, age greater than 65 years, and obesity, as recommended by 1.
Monitoring and Follow-up
- Patients should be monitored for complications, including anastomotic leak, ileus, surgical site infection, and bleeding, and follow-up appointments should be scheduled 1-2 weeks after discharge to assess healing and address any concerns, as suggested by 1 and 1.
- Stoma care, if applicable, requires education on proper appliance changing, skin care, and recognition of complications, as recommended by 1 and 1.
Evidence-Based Recommendations
- The use of ERAS principles in colorectal surgery is recommended to improve immediate postoperative recovery, as suggested by 1.
- The components of ERAS protocols, including preoperative counseling, optimization of comorbidities, and multimodal pain control, should be tailored to the specific needs of patients with inflammatory bowel disease (IBD), as recommended by 1.
- Thromboprophylaxis should be extended after discharge in patients with relevant risk factors, as recommended by 1.
From the Research
Post Colectomy Management
- The management of post colectomy patients involves the use of antibiotics to prevent surgical wound infection 2.
- A study found that the combination of IV metronidazole with or without PO vancomycin showed superior outcomes in terms of a shorter ICU length of stay and more ventilator-free days 3.
- The use of prophylactic antibiotics before colorectal surgery has been shown to reduce the risk of surgical wound infection by as much as 75% 2.
- Antibiotics covering aerobic and anaerobic bacteria delivered orally or intravenously (or both) prior to elective colorectal surgery are effective in reducing the risk of surgical wound infection 2.
Antibiotic Regimens
- A study compared four different antibiotic regimens (A, B, C, and D) and found that the combination of IV metronidazole with or without PO vancomycin showed superior outcomes 3.
- The use of metronidazole and ciprofloxacin for 28 days has been shown to be effective in treating recurrent or refractory pouchitis 4.
- Ciprofloxacin is a broad-spectrum fluoroquinolone antibacterial agent that is effective in treating a wide variety of infections, including those caused by Gram-negative pathogens 5.
Nutritional Support
- Artificial nutritional support should be administered, whenever possible, and is well managed with through the enteral route 6.
- Early post-surgery enteral nutrition (EN) or oral supplements seems to be beneficial 6.
- The implementation of a specific nutritional support protocol allows for decreasing parenteral nutrition (PN) and shortens hospital stay 6.