What is the post-operative management of cholecystitis?

From the Guidelines

Post-operative management of cholecystitis should focus on pain control, infection management, and early mobilization, with a key principle being the avoidance of unnecessary post-operative antibiotics in uncomplicated cases, as supported by the most recent guidelines 1. The management strategy should include:

• Pain control using a multimodal approach with acetaminophen, NSAIDs, and opioids as needed
• Infection management, which, according to the latest recommendations 1, does not require post-operative antibiotics for uncomplicated cholecystitis if the focus of infection is controlled by cholecystectomy
• Early ambulation to prevent venous thromboembolism and respiratory complications
• Diet progression from clear liquids to regular as tolerated
• Wound care to keep the incision clean and dry For uncomplicated cholecystitis, the use of post-operative antibiotics is not recommended 1, as studies have shown that postoperative antibiotics do not decrease postoperative infection rates in such cases. In contrast, complicated cholecystitis may require antibiotic therapy for 4 days in immunocompetent patients or up to 7 days in immunocompromised or critically ill patients, based on clinical conditions and inflammation indices 1. Early discharge, typically within 1-2 days for laparoscopic procedures, can be considered if the patient has adequate pain control, is tolerating oral intake, and shows no signs of complications, with follow-up scheduled for 1-2 weeks post-discharge.

From the Research

Post-Operative Management of Cholecystitis

The post-operative management of cholecystitis involves several key considerations to ensure a smooth and effective recovery. Some of the key aspects include:

• Pain management: Effective pain control is crucial in the post-operative period to prevent complications and promote recovery 2.
• Management of post-operative nausea and vomiting (PONV): PONV is a common complication after laparoscopic cholecystectomy, and its management is essential to prevent dehydration and electrolyte imbalances 2.
• Monitoring for complications: Patients should be closely monitored for complications such as bleeding, infection, and respiratory problems 3, 4.
• Wound care: Proper wound care is essential to prevent infection and promote healing 4.

Specific Considerations

Some specific considerations in the post-operative management of cholecystitis include:

• The use of a multimodal anaesthetic/analgesic regime to reduce pain and PONV 2.
• The importance of early surgical intervention in cases of acute cholecystitis 3.
• The need for a multidisciplinary approach in the management of high-risk, critically ill, and unfit-for-surgery patients 5.
• The use of percutaneous gallbladder drainage as a bridge to surgery or as a definitive procedure in severely physiologically deranged patients 5.

Risk Factors for Complications

Several risk factors have been identified for complications after laparoscopic cholecystectomy for acute cholecystitis, including:

• Age: Older patients are at higher risk for complications 6.
• Male gender: Male patients are at higher risk for conversion to an open procedure 6.
• Body mass index (BMI): Patients with a higher BMI are at higher risk for complications 6.
• Preoperative alkaline phosphatase and white blood cell count: Elevated levels of these markers are associated with an increased risk of complications 6.