Time points | Interventions |
---|---|
Preoperative | |
No enteral bowel preparation | |
Two high enemas the evening before surgery | |
Normal nutrition till midnight before surgery | |
Clear drinks including carbohydrate till 2 h before surgery | |
Subcutaneous injection of low molecular heparin at 20:00 hours | |
Intraoperative | |
DVT prophylaxis with T.E.D.™ hose or sequential compression devices | |
Perioperative antibiotics 30 min before surgical incision | |
Restrictive fluid regimen aiming at zero postoperative weight gain | |
Gastrostomy tube placed, removal of orogastric tube at end of procedure | |
Postoperative | |
DVT prophylaxis with ambulation, T.E.D.™, and subcutaneous low molecular heparin (weight adapted), started 6 hours postoperatively | |
Chewing gum encouraged | |
Clear drinks allowed the same evening after surgery | |
Gastrostomy tube initially left on drainage; closure of the gastrostomy tube will occur when patient is without nausea and vomiting for >24 h | |
Bedside mobilization as soon as possible, ideally the same evening after surgery, but if this is not possible, not later than the next morning | |
Initial pain treatment with thoracic epidural analgesia, no opioids | |
GI ulcer prophylaxis with esomeprazole for at least the first 2 POD | |
Antibiotics for 48 hours | |
Ambulation on POD 1 | |
Start oral fluids including energy drinks (Ensure®, Impact®) on POD 1 | |
Unrestricted clear drinks on POD 1 | |
Prokinetics: start with 0.5 mg neostigmin subcutaneously up to 4 times per day on POD 2 | |
Small snacks introduced on POD 2, not later than POD 3 | |
POD 3: encourage longer mobilization, walking distances, and spending time in a chair | |
Anti-emetics given only on request | |
Drains removed if draining <50 ml/day | |
Gastrostomy tube removed once the patient has passed stool | |
POD 5: thoracic epidural removed, oral analgesics (metamizole, paracetamol, hydroxycodon/naloxon (Targin®)) |