From the Guidelines
Patient education for cholecystectomy should prioritize informing patients about the risks of bile duct injury, a serious complication that can occur during the procedure, and the importance of prompt identification and management to minimize morbidity, mortality, and long-term quality of life impacts. According to the 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy 1, bile duct injuries are a significant concern, occurring in 0.4-1.5% of laparoscopic cholecystectomies and associated with substantial postoperative sequelae.
Preoperative Education
Before surgery, patients should be educated on:
- Fasting instructions, typically nothing by mouth 8-12 hours before surgery
- Temporarily stopping certain medications like blood thinners as directed by their surgeon
- The risks and benefits of the procedure, including the risk of bile duct injury
Postoperative Care
After surgery, patients should expect:
- Some pain at incision sites, manageable with prescribed pain medications such as acetaminophen or NSAIDs, and occasionally short-term opioids like hydrocodone/acetaminophen (Norco) for severe pain
- Gradually increasing physical activity while avoiding heavy lifting (nothing over 10 pounds) for 4-6 weeks
- Eating small, low-fat meals initially
- Watching for complications such as fever, increasing pain, wound drainage, or yellowing skin
Recovery and Follow-Up
Most patients can return home the same day for laparoscopic procedures or after 1-2 days for open surgery. Recovery activities and follow-up care should include:
- Monitoring for signs of bile duct injury or other complications
- Follow-up appointments with their surgeon to assess healing and address any concerns
- Guidance on when to return to work, typically within 1-2 weeks for desk jobs or 4-6 weeks for physically demanding work
Long-Term Considerations
Long-term dietary restrictions are usually unnecessary once fully recovered, though some patients may benefit from continuing to limit fatty foods. The guidelines provided by the 2020 WSES 1 and other studies 1 emphasize the importance of patient education and prompt management of complications to ensure proper healing and minimize the risk of long-term quality of life impacts.
From the Research
Patient Education After Cholecystectomy
Patient education after cholecystectomy is crucial to manage symptoms and prevent complications. The following points should be considered:
- Postcholecystectomy syndrome (PCS) is a complex of symptoms from the gastrointestinal tract that can develop and maintain after cholecystectomy 2.
- Symptoms of PCS include abdominal pain, dyspepsia, constipation, diarrhea, nausea, bloating, and fatty food intolerance 2.
- Gastric symptoms of PCS occur in one third of patients after elective cholecystectomies, and complete PCS develops after 3 months postoperatively, likely connected with the change of diet 2.
Management of Postcholecystectomy Symptoms
Management of postcholecystectomy symptoms is essential to improve patient outcomes. Key points include:
- Cholecystectomy successfully resolves biliary colic in most patients, but some patients may experience persistent abdominal pain after 6 months of follow-up 3.
- Symptoms such as flatulence, restricted eating, frequent bowel movements, bowel urgency, and diarrhea may persist or develop after cholecystectomy 3.
- Etiologies of long-term postcholecystectomy symptoms include residual and newly formed gallstones, coexistent diseases, psychological distress, surgical complications, and physiological changes 4.
- Sphincter of Oddi dysfunction (SOD) is reported as an etiology for both persistent and incident symptoms after cholecystectomy 4.
Antibiotic Use in Cholecystectomy
Antibiotic use in cholecystectomy is recommended in certain situations:
- Routine use of peri-operative antibiotic agents is not recommended in low-risk patients undergoing elective laparoscopic cholecystectomy 5.
- Peri-operative antibiotic agents are recommended for patients undergoing laparoscopic cholecystectomy for acute cholecystitis 5.
- Post-operative antibiotic agents are not recommended after elective laparoscopic cholecystectomy for symptomatic cholelithiasis or mild or moderate acute cholecystitis 5.