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

Patients are admitted to the hospital postoperatively and transported to a recovery area immediately after the procedure. The Foley catheter can either be removed after the operation concludes or remain in place based on surgeon preference, intra­operative ndings, and clinical status. Antibiotics are generally not indicated post­operatively and should be discontinued within 24h of the operation. Postoperative goals of the ERAS protocols aim for adequate pain control, prevention of nausea and vomiting, and facilitation of early nutrition and mobilization. Judicious uid administration continues in the postoperative period. IV uids should be stopped as soon as the patient can tolerate oral liquids. Crystalloids are run at 1mL/kg/h post­operatively and discontinued after 6h or after 300 mL of oral intake, whichever occurs rst. Patients can be treated with a nite number of small uid boluses if necessary to treat hemodynamic instability or inadequate urine output. A clear liq­uid diet can be started within a few hours of the conclusion of the procedure and supplemented with high-calorie beverages. If post-operative nausea/vomiting (PONV) develops, diet advancement is delayed until symptoms have resolved. Early diet advancement has been shown to result in earlier return of bowel function and shorter length of stay without increased rates of nasogastric tube reinsertion or anastomotic complications [35]. Pain continues to be managed with a multimodal approach using medications from multiple different non-opioid classes including acetaminophen, NSAIDS, muscle relaxers, and gabapentinoids. Opioid medications can be supplemented as needed for pain control. Early mobilization (on postopera­tive day 0) is essential to prevent postoperative pneumonia and thromboembolic events [36, 37]. C-Reactive Protein (CRP) levels have been shown to be early pre­dictors of postoperative complications. Post-operative day 3 CRP >150 mg/L or persistent elevation of CRP should increase suspicion of an infectious complication. CRP levels below threshold are highly predictive of an uncomplicated recovery and are commonly used in ERAS protocols to guide discharge [38, 39]. It is common for patients to experience loose stools and increased frequency of bowel movements, which often resolves within 4–6months after surgery. If alvimopan is given preop­eratively, it is continued in the postoperative period until the patient’s bowel func­tion returns. Return of bowel function does not necessarily correspond with PO tolerance and is therefore no longer required before hospital discharge [40]. Discharge often depends on varying criteria related to oral food intake, ambulatory status, and bowel function. There is a movement towards same day discharge for some, highly selected patients [41]. Patients are instructed to avoid heavy lifting for 4–6weeks to minimize risk for incisional hernia formation. Subcutaneous heparin injections may be prescribed on discharge. Clinical practice guidelines recommend a total of 10–14days of low-molecular-weight heparin after operations for benign colorectal pathology and 28days total in patients with inammatory bowel disease or malignant colorectal pathology [42].