Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_832_Библиотеки_им_академика_М_И_Перельмана

Post-operative ileus is one of the most frequent problems after abdominal surgery [17]. The length of time to return of bowel function is highly variable and depends on multiple patient factors. Close attention should be paid to electrolyte and uid imbalances both intra- and post-operatively; all attempts should be made to prevent hypervolemia and volume overload. A foley catheter can be safely left in place until post-operative day 1 or 2in order to accurately monitor urine output and ensure adequate resuscitation. Nasogastric tubes are often placed intra-operatively but should not be routinely continued after every small bowel resection. Post-operative continuation of nasogastric decompression may be considered in certain clinical situations including but not limited to: the patient is unstable, septic, or at high risk for aspiration; the patient was obstructed preoperatively; the surgery was compli­cated by gross contamination; or the patient is high risk for post-operative ileus. If a nasogastric tube is left in place, it should be connected to low-intermittent wall suction and the quality and quantity of output should be monitored every shift. When the volume of output has decreased to less than 150–200cc per 8h shift and is not bilious, the tube can be removed. Tube clamping trials can also be considered prior to tube removal based on the clinical situation and surgeon preference. Oral intake can be started at the surgeon’s discretion. Traditionally, oral intake was with­held until the patient started passing atus. However, many studies have shown that early initiation of enteral feeding can promote earlier return of bowel function, reduce the overall risk of infection, and decrease hospital length of stay [18–21]. Multimodal post-operative analgesia should be administered and narcotics mini­mized as much as possible to reduce opioid-associated delayed gastrointestinal recovery [20]. Early mobility is also strongly encouraged to aide in faster recovery; adequate pain control is important to ensure that patients can be as active as possible [21]. Post-operative antibiotics are not routinely indicated, as prolonged use increases the risk of Clostridium difcile infection and the development of resistant bacteria [4]. The patient can be discharged home when they are tolerating a diet, have had reliable return of bowel function, are ambulating safely and without dif­culty, and have good pain control on oral medications.