Kaohsiung Armed Forces General Hospital

Pingtung Branch of Kaohsiung Armed Forces General Hospital

Postoperative Instructions for Biliary Tract Surgery

I. Postoperative Care Instructions

1. 1.After surgery, follow your doctor’s instruction before resuming oral intake. Begin with a gradual diet. Medical staff will inform you when you may start eating. Typically, you will start with small sips of water. If there are no adverse reactions, you may try sports drinks, honey tea, or pulp-free juice. Then, gradually move to light, easily digestible soft foods.
2. After the surgery, you may have a surgical wound drain, a bile drainage tube (T-tube), and a urinary catheter in place.
3. When moving or turning in bed, support the surgical wound with a soft pillow or abdominal binder and press gently with both hands to reduce pain.
4. Notify nursing staff if you experience wound pain.
5. If a T-tube is in place, patients will be instructed to observe the amount, color, and nature of bile drainage. The bile color typically changes from reddish to brown-green. If there is oozing from the wound or continuous drainage of fresh blood or abnormal fluid color, notify the medical staff immediately.
6. You may experience temporary nausea or vomiting due to anesthesia.
7. For laparoscopic biliary surgery, carbon dioxide is introduced into the abdominal cavity to create space. Some gas may remain postoperatively, so avoid gas-producing foods.

II. Postoperative Day 1

1. Begin getting out of bed and moving gradually as soon as possible to promote bowel movement and prevent blood clots in the legs.
2. Avoid bending, twisting, or pulling on tubes. If any tube slips out, notify the medical staff immediately.
3. While lying in bed, place drainage tubes flat on the bed. When sitting up or walking, hold the tubes gently or place them in a shirt pocket, or secure them with a clip on your clothing to reduce wound pain. Drains are usually removed before discharge or at a follow-up visit with your doctor’s approval.
4. To prevent complications such as atelectasis or pneumonia after general anesthesia, perform deep breathing, back-patting, and coughing exercises frequently to help expel mucus. When coughing, press on the wound gently with your palm, a pillow, or use an abdominal binder to reduce pain.
5. Keep the wound clean and dry. The doctor will change the dressing and assess the drainage daily. If you notice redness or itching around the drain site, inform medical staff. Do not apply ointments or scratch the area by yourself.

III. Postoperative Days 2–7

1. Medical staff will advise when you can resume eating. Start with a small amount of water. If you do not experience nausea or vomiting, gradually begin a low-fat diet. Avoid fried, fatty, and high-cholesterol foods such as fried chicken, chicken skin, fish belly, pork knuckles, organ meats, whole milk, egg yolks, lard, avocados, durians, sesame oil, mayonnaise, and satay sauce. Opt for clear soups, steamed, or boiled foods instead of fried or grilled items. Choose lean meats and consume plenty of dark green and yellow vegetables and fruits rich in vitamins such as guava, citrus fruits, papaya, and fresh leafy greens.
2. A cholangiography (bile duct X-ray) using the T-tube will be scheduled about one week after surgery. If no residual bile sludge, stones, or leaks are found, the T-tube may be secured in place for observation. If there are no symptoms such as fever or abdominal pain, the doctor may shorten the T-tube and remove sutures or allow you to go home with the tube and take care of it yourself.

IV. Post-Discharge Instructions

1. You may resume light work one week after surgery. Normal activities can be resumed after one month, but avoid strenuous activities for at least three months.
2. If any drains are still in place after discharge, follow the instructions given by the medical team for wound care and record daily drainage amounts. Return to the clinic immediately if you experience abdominal bloating or pain, tube dislodgement, bright red, cloudy, or foul-smelling drainage, or if drainage suddenly increases, decreases, or stops.
3. A follow-up appointment will be scheduled 4–6 weeks after surgery for a cholangioscopy and removal of any remaining drainage tubes.
4. Keep the wound clean and dry. Take medications as prescribed and attend follow-up appointments as scheduled.
5. Seek immediate medical attention if you experience redness, swelling, heat, pain at the wound site, fever, abdominal pain, jaundice, tea-colored urine, or pale/gray stools after returning home.