What are the precautions after choledochal cyst surgery?

  1.What are the precautions after surgery for congenital common bile duct dilatation (common bile duct cyst)?  (1) After resuscitation by anesthesia, postoperative children routinely return to the general ward and are given cardiac monitoring, oxygen, etc., and sputum when necessary; if the condition requires, they need to be intubated with a trachea and admitted to the Pediatric Intensive Care Unit (PICU) for monitoring and treatment, which is more expensive and the hospital stay may be extended.  (2) Tube management: After surgery, one gastric tube, one urinary tube and one hepatic portal drainage tube are routinely kept, and one jugular vein tube is kept in most children; the decision of when to remove the above drainage tubes or puncture tubes is made according to the recovery of the child after surgery, and parents should take proper care of the child to prevent the child from removing the above tubes by himself.  (3) Diet: Fasting is required for 3-5 days after surgery. After the recovery of intestinal function, anal venting and defecation, the gastric tube should be removed before drinking, and gradually transition to normal diet after no discomfort.  (4) Intravenous rehydration: broad-spectrum antibiotics, hemostatic drugs, intravenous nutritional support and hepatoprotective therapy should be given after surgery, which usually lasts for 5~7 days.  (5) Blood transfusion therapy: If the child’s abdominal cavity drains more bloody exudate after surgery, or if the postoperative routine blood test indicates moderate anemia, blood products such as concentrated red blood cells, plasma, platelets or cold precipitation should be transfused if necessary.  (6) Incision care: Routine postoperative drug change 1 to 3 days, and every 2 to 3 days thereafter. If the incision is red, swollen, exuding or infected, TDP illumination and daily drug change should be given; if necessary, the incision should be re-drained or even cleared and sutured.  (7) Blood sampling: Regular blood sampling is required for routine blood tests, blood gas analysis + electrolytes, liver function, etc. after surgery.  (8) Imaging examination: routine ultrasound examination should be performed 1 to 2 times after surgery.  2.What kind of cases can be discharged?  Discharge criteria: no fever, nausea, vomiting, abdominal distension, diarrhea, normal exhaustion and defecation, good healing of abdominal incision, no redness, swelling and exudation. The results of routine blood and electrolytes were normal, liver function was normal or close to normal, and ultrasound of liver was normal on review.  Because of the preoperative liver damage in children with congenital common bile duct dilatation, the liver damage may be further aggravated by anesthesia and the blow of major surgery, and it is difficult to reduce the indexes of liver function, especially glutathione transaminase, to normal after surgery, and it takes 3 to 6 months for the liver function to completely return to normal, so it is not necessary to wait for the liver function to be completely normal to reach the discharge standard.  3.What should I do after discharge?  After discharge from the hospital, regular review is required. The frequency of review is as follows: 1st time: 2 weeks after surgery, you need to review in the surgical outpatient clinic, bringing clinical information such as outpatient medical records, discharge summary, etc. If necessary, you need to draw blood to review liver function or liver ultrasound examination. The 2nd time: 1 to 3 months later, review again to understand the incision condition and liver function, etc. The review will be done every 2 to 3 months for 12 months after surgery, and every 3 to 6 months after 1 year until the age of 18 years.