From the Guidelines
Post-operative care for a patient after open cholecystectomy should prioritize early oral feeding, multimodal opioid-sparing analgesia, and early mobilization to minimize complications and facilitate recovery, as recommended by the most recent and highest quality study 1. The goal of post-operative care is to ensure proper healing, minimize complications, and facilitate the patient's return to normal function after the significant physiological changes resulting from gallbladder removal.
Key Components of Post-Operative Care
- Early Oral Feeding: Oral fluids should be initiated as soon as the patient is lucid after surgery, and solids should be introduced after 4 hours, as this has been shown to lead to significantly shortened hospital length of stay and reduced complications 1.
- Multimodal Opioid-Sparing Analgesia: A combination of paracetamol and NSAID should be given orally, with additional use of non-opioid drugs if needed, to minimize opioid use and reduce the risk of opioid-related complications 1.
- Early Mobilization: Patients should be encouraged to mobilize for 30 minutes on the day of surgery and 6 hours/day thereafter to prevent atelectasis and venous thromboembolism 1.
- Wound Care: The surgical site should be kept clean and dry, with dressings changed daily or as directed, and monitored for signs of infection such as increased redness, swelling, warmth, or drainage.
- Follow-up Appointments: Patients should be scheduled for follow-up appointments 1-2 weeks post-discharge to assess wound healing and recovery progress. By prioritizing these key components of post-operative care, patients can expect a smoother and more rapid recovery after open cholecystectomy, with reduced morbidity, mortality, and improved quality of life. Some of the other essential perioperative care interventions for elective abdominal surgery at primary and secondary hospitals in low-middle-income countries (LMIC’s) include:
- Preoperative education and optimization
- Selective use of mechanical bowel preparation
- Fasting and carbohydrate loading
- Premedication and intraoperative care items such as surgical safety checklist, antimicrobial prophylaxis, and postoperative nausea and vomiting (PONV) prophylaxis
- Venous thromboembolism (VTE) prophylaxis and standard anesthesia protocol
- Normothermia and multimodal opioid-sparing analgesia
- Fluid balance and minimally invasive surgery (MIS)
- Avoidance of nasogastric tubes (NGT) and drains
- Audit and evaluation of processes of care, compliance to guidelines, and outcomes 1.
From the Research
Postoperative Care for Open Cholecystectomy
There are no research papers directly related to postoperative care for open cholecystectomy. However, some studies provide information on postoperative care for laparoscopic cholecystectomy and management of postcholecystectomy complications.
Pain Management
- Paracetamol combined with NSAIDs or cyclo-oxygenase-2 inhibitors can be given either pre-operatively or intra-operatively for pain management, unless contraindicated 2
- Intra-operative intravenous (i.v.) dexamethasone, port-site wound infiltration or intraperitoneal local anaesthetic instillation are recommended for pain management 2
- Opioids can be used for rescue analgesia 2
- Oxycodone/paracetamol combination can be useful for moderate-to-severe pain, including postoperative pain 3, 4
Management of Complications
- Obtaining a critical view of safety and following the other tenets of the Safe Cholecystectomy Task Force can aid in the prevention of bile duct injury and other morbidity associated with cholecystectomy 5
- Nurses can prevent and recognize complications by implementing best practices in phase I, phase II, and phase III recovery 6