From the Research
Post-operative management for a patient on POD 1 after laparoscopic paraesophageal hernia repair with EGD should focus on pain control, early mobilization, respiratory care, and gradual diet advancement. Pain management typically includes scheduled acetaminophen 1000 mg every 6 hours, supplemented with opioids such as hydrocodone/acetaminophen 5/325 mg every 4-6 hours as needed for breakthrough pain, as seen in various studies 1, 2, 3. Some key points to consider in post-operative management include:
- Early mobilization to prevent venous thromboembolism, with mechanical prophylaxis using sequential compression devices and possibly chemical prophylaxis with enoxaparin 40 mg subcutaneously daily 2
- Respiratory care includes incentive spirometry every hour while awake to prevent atelectasis
- Diet typically begins with clear liquids on POD 1, advancing to full liquids if tolerated, with a plan to progress to soft foods over 1-2 weeks
- Patients should be monitored for complications such as dysphagia, gas-bloat syndrome, and signs of recurrence
- Proton pump inhibitors like pantoprazole 40 mg daily should be continued to reduce acid production and promote healing, as suggested by studies 4, 5 It's also important to note that while some studies may suggest varying approaches to post-operative management, the most recent and highest quality study should be prioritized, such as the one published in 2020 4. Additionally, the patient's specific condition and medical history should be taken into account when making decisions about their post-operative care. Some potential complications to watch for include thrombocytopenia, as seen in a case report from 2020 4, and acute esophageal necrosis, as reported in a case study from 2007 5. Overall, a comprehensive approach to post-operative management is crucial to ensuring the best possible outcomes for patients after laparoscopic paraesophageal hernia repair with EGD.