Laparoscopic Cholecystectomy Presentation

Laparoscopic Cholecystectomy

-same day surgery

-smaller incisions

-less pain after surgery

-quicker recovery

Laparoscopic cholecystectomy is the removal of the gallbladder. This is a less invasive way to remove the gallbladder. This surgery uses a laparoscope, which is a camera used to see the inside of the body and three other small incisions are made. With open surgery, incisions are made in the right upper part of abdomen in five to eight inch long incisions. Most laparoscopic cholecystectomies are same day surgery, have smaller incisions, and patients experience less pain after surgery and have a quicker recovery.

SLIDE 2

Problems with laparoscopic cholecystectomy in post operative phase pain nausea/vomiting length of stay patient dissatisfaction

When patients have a laparoscopic cholecystectomy in an outpatient setting, patients have post op pain and nausea in the post-operative phase. “Pain is the most common symptom following laparoscopic cholecystectomy (LC) and might delay discharge from hospital after day surgery” (Barthelsson, Nordstrom, & Norberg, 2011, p. 143). At Kaiser Permanente we began hearing more reports of postoperative pain and nausea and vomiting after this procedure. Due to these symptoms the length of stay in the outpatient setting were taking longer than expected and therefore patients and families felt dissatisfied with the care.

SLIDE 3

PICOT QUESTION

For adult patients undergoing laparoscopic cholecystectomy, do patients have less pain and nausea during post-operative phase if given pain medication in pre-operative phase and nausea medication in intra-operative phase?

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... the first 24 hours, due to anesthesia and pain medications. No strenuous activity and no lifting for two weeks are considered imperative for the recovery. Keeping dressings clean and dry for 48 hours and monitoring for signs of infections and bleeding helps promote a quick recovery.

When going over discharge instructions, it is really important to let the patient and family know whom they can call for questions or concerns. At Kaiser Permanente we have a 24 hours advice nurse line and call center that is able to contact the surgeon for any concerns. The patient may also contact the surgeon’s clinic or email the surgeon for non-urgent questions. Follow up appointments are scheduled at this time. If the patient is experiencing chest pain, shortness of breath or feeling like passing out, they are instructed to go to the nearest emergency department or call 911.