Editing Intestinal Segments and Urinary Diversion (section)

== Postoperative care ==

* The use of nasogastric or gastrostomy decompression during the postoperative period of ileus is somewhat controversial.
** The use of a nasogastric tube in the postoperative period reduces postoperative vomiting.
** '''The fluid lost via a nasogastric tube used to manage paralytic ileus is isotonic and alkaline. Therefore, this should be replaced with Lactated Ringer's§''' that also provides replacement with approriate levels of potassium, chloride, and bicarbonate.
*** Saline with KCl supplementation would be more appropriate for replacement of gastric secretions.
* Diet
** Clear liquids may be begun when the paralytic ileus resolves and bowel activity resumes. If clear liquids are tolerated, the diet may be advanced. This sequence of events generally takes 1-4 days.
*** '''If the nutritional condition of the patient is impaired preoperatively, a postoperative complication delays oral feeding, or the paralytic ileus is still present on the 5th postoperative day, the patient should receive IV nutrition.'''
**** It is preferable to begin the hyperalimentation the day after surgery if any of these complications are anticipated.
* '''Enhanced recovery after surgery (ERAS) protocols aim to improve surgical outcomes by reducing variation in perioperative best practices.'''
** '''2016 meta-analysis'''
*** '''13 studies'''
*** '''Results'''
**** '''ERAS was associated with reduced complication rates, time to return of bowel function, and shorter LOS.'''
**** '''No difference in overall readmission rates, though slightly reduced readmissions at 30 days in the ERAS group.'''
*** Tyson, Mark D., and Sam S. Chang. "Enhanced recovery pathways versus standard care after cystectomy: a meta-analysis of the effect on perioperative outcomes." European urology 70.6 (2016): 995-1003