Is it reasonable to feed a patient waiting for a laparoscopic cholecystectomy (lap chole) after surgery has been cancelled for the day?

Feeding a Patient Awaiting Laparoscopic Cholecystectomy After Surgery Cancellation

Yes, it is reasonable and beneficial to feed a patient waiting for a laparoscopic cholecystectomy after surgery has been cancelled for the day. 1 Early feeding is associated with improved outcomes and does not increase complication rates in patients awaiting abdominal surgery.

Evidence-Based Rationale

Benefits of Feeding Patients Awaiting Surgery

• Early nutrition is supported by current Enhanced Recovery After Surgery (ERAS) guidelines, which recommend proactive management of postoperative diet and nutrition 1
• Avoiding unnecessary fasting helps prevent nutritional deficits that could negatively impact surgical outcomes
• An RCT of emergency general surgery patients showed no increase in complications with feeding within 24 hours compared to traditional nil-by-mouth approaches 1

Specific Considerations for Laparoscopic Cholecystectomy Patients

• For patients awaiting laparoscopic cholecystectomy:
  • Prolonged fasting offers no clinical benefit
  • Maintaining nutritional status is important for optimal surgical outcomes
  • Unnecessary fasting can lead to increased patient discomfort and hunger

Implementation Approach

Assessment Before Feeding

1. Confirm the surgery is definitely cancelled for the day (not just delayed)
2. Ensure the patient has no specific contraindications to oral intake:
   • No signs of bowel obstruction
   • No planned emergency surgery within the next few hours
   • No severe nausea/vomiting

Feeding Recommendations

• Start with clear liquids and advance diet as tolerated
• Avoid very fatty meals that might trigger biliary colic
• Consider a low-fat diet if the patient has been symptomatic with fatty foods

Potential Concerns and Mitigation

Surgical Considerations

• The traditional practice of keeping patients NPO (nil per os) "just in case" surgery might be rescheduled is not evidence-based
• ESPEN guidelines note that preoperative fasting from midnight is unnecessary in most patients 1
• If surgery is rescheduled for the following day, standard preoperative fasting guidelines can be implemented at that time

Patient Comfort and Satisfaction

• Feeding patients when safe to do so improves patient comfort and satisfaction
• Unnecessary prolonged fasting can contribute to patient distress and dehydration

Key Pitfalls to Avoid

1. Assuming all surgical patients need to remain NPO indefinitely: This outdated practice is not supported by current evidence and can lead to unnecessary nutritional deficits
2. Failing to communicate with the surgical team: Always confirm the surgery plan before initiating feeding
3. Ignoring patient symptoms: If the patient has active nausea, vomiting, or severe abdominal pain, a more cautious approach may be warranted

In summary, when a laparoscopic cholecystectomy has been cancelled for the day, feeding the patient is not only reasonable but aligns with current best practices in perioperative care. This approach helps maintain nutritional status and improves patient comfort without increasing surgical risks.