Physiotherapy in

abdominal surgery
A.THANGAMANI RAMALINGAM
PT, MSc(PSY),MIAP

Common
operations

Gastrectomy
Cholecystectomy
Appendecectomy
Colectomy
Colostomy
Ileostomy
Herniotmy/ Herniorrhaphy/plasty
Nephrectomy
Prostatectomy
Cystectomy
Mastectomy
Hysterectomy

Gastrectomy
Removal

of all or part of the stomach

gastrectomy was mostly used as a
treatment for stomach/duodinal
ulcers, however now this procedure
is used primarily for cancer of the
stomach
Partial /total gastrectomy

Causes
Peptic

ulcer( gastric/duodenal)
Pyloric stenosis
Zollinger-ellison syndrome
(hypergastrinaemia)
Malignancy (gastrinoma)

Operations

Vagotomy
Pyloroplasty
Gastrojeunostomy
Antrectomy (1/3 of stomach excised)
Partial gastrectomy(2/3 of distal stomach excised)
Total gastrectomy
Billroth I gastro-duodenal anastomosis-gastric
ulcer
Polya operation-gastro-jejunal anastomosisduodenal ulcer
Sleeve gastrectomy
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 Nasogastric

tube in situ (two hourly

suction)
3rd day liquid diet
5th or 6th day normal diet

complications
Resp/circulatory/electrolyte

imbalance
early complications (with in a year)
paralytic ileus, stomal obstruction,
duodenal blow out, post dumping
syndromes, pancreatitis, vomiting
Late complications
recurrent ulcer, fistula, nutritional
deficiency, intestinal
obstruction,TB,gallstones
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Post-operative care
Depending on the severity of the
surgery, the patient may be sent to a
regular surgical room or may be sent to
the surgical intensive care unit to be
more closely monitored
The nasogastric tube is left in place and
connected to suction to keep the
stomach empty. The tube is removed
when stomach and bowel function
returns to normal, usually in 2 - 3 days
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Fluids are given by vein (intravenously, I.V.)

Antibiotics are usually given I.V. for 24 hours

Oxygen may be given by nasal catheter

Gradually the diet is increased from liquids to soft food and

then more solid foods. A special diet may be necessary for many
of the patients with a gastrectomy

The wound is kept clean to prevent infection. Lotions should

not be applied to the wound

If radiation therapy or chemotherapy is given, there will be

follow up with a radiologist or oncologist.

Blood tests, CT scans and other diagnostic tests may be

necessary to follow the course of the disease

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Physiotherapy

Common pre-op training

Post op assessment
Problems
1.increased production of mucus
secretions of lower lobe of left lung
2.inhibited cough reflex due to pain &
ryles tube
3.tiredeness-anaemia-less RBC production
4.haemetemesis
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Treatment

Chest pt
Encourage cough reflex
Treat for short duration
Arm/leg exs
Early mobilization-prop up in the evening or next
day
Wound care
Micturition /bowel
Pain relief
Oral hygiene
Diet
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Cholecystectomy
the

operation for removal of the gall

bladder

Laparoscopic

Cholecystectomy

ERCP

(Endoscopic Retrograde
Cholangio-Pancreatography
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Causes
Acute/chronic

cholecystitis

Cholelithiasis
Volvulus

cholesterosis
carcinoma

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Operations
Mini

cholecystectomy
Cholecystostomy
Extended with hepatic lobectomy
cholecystolithotomy

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 Kochers

incision
Right upper paramedian incision
T TUBE/cigarette drain/under water
seal drain/corrugated rubber sheet
Duct-first/fundus first method

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Complications
Damage

to bile duct/right hepatic

artery/cystic artery
Waltman-walters syndrome
bile leakage,chest/abs pain
mimics pulmonary embolism/highly
fatal

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Physiotherapy
Problems

1.increased production of mucus

secretions of lower lobe of right lung
PT as per protocol

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