Objective The objective of this study is to evaluate the effect of enhanced recovery after surgery (ERAS) in the perioperative period of pancreatoduodenectomy. Methods This article conducted the forward-looking analysis on the information of 227 patients undergoing the pancreatoduodenectomy in West China Hospital from January 2016 to June 2017, and then compared the differences between the patients subjected to ERAS (ERAS group) and thosesubjected to regular measures (control group) with respect to time of setting in sickbed, time of mobilizing out ofsickbed, time of starting drink water, time of resumption of diet, exhaust time, defecation time, the time of nasogastric tube, postoperative hospitalization duration and expenses, postoperative complications, and postoperative pain scores. Results ① Postoperative indexes: by comparison of the ERAS group and the control group, it was found that the ERAS group had shorter (or lower) time of setting in sickbed, time of mobilizing out of sickbed, time of starting drink water, time of resumption of diet, exhaust time, defecation time, the time of nasogastric tube, postoperative hospitalization duration and expenses (P<0.05). ② Postoperative complications: of all postoperative complications, including pancreatic fistula, postoperative hemorrhage, delayed gastric emptying, biliary fistula, abdominal infection, incision complication, lung infection, and heart complication were without statistically significant differences (P>0.05) between the 2 groups.③ Reoperation and readmission: there was no significant difference on the incidences of reoperation and readmission between the 2 groups (P>0.05). ④ Postoperative pain scores: except 22 : 00 of the 6-day after operation, the pain scores in the ERAS group were all lower than those in the control group at 2 h and 8 h after operation, and the time points of 1–6 days after operation (8 : 00, 16 : 00, and 22 : 00), with statistically differences (P<0.05). Conclusion Without increasing the incidence of complications, ERAS may speed up the rehabilitation of patients undergoing the pancreatoduodenectomy and mitigate the pain of patients.
Objective To summarize contents of enhanced recovery after surgery (ERAS) and understand it’s status and prospect in application of patients with hepatolithiasis. Methods The descriptions of ERAS in recent years and applications in hepatolithiasis were reviewed. Results The ERAS programme mainly included the preoperative managements, such as the education, nutrition management, and gastrointestinal tract management; the intraoperative managements, such as the minimally invasive surgery, reasonable choice of anesthesia, infusion volume management, and maintenance of body temperature, analgesia, and preventing postoperative nausea and vomiting medication selection; the postoperative early feeding, early exercise, early extubation, multimodal analgesia, T tube management, reasonable discharge standard and follow-up management. Although the ERAS was rarely reported in patients with hepatolithiasis, it had some advantages of promoting recovery and improving patient satisfaction, and it was still effective and safe. Conclusions Application of ERAS concept in patients with hepatolithiasis has achieved precision management and individualized treatment during perioperative period. It could achieve a good short-term therapeutic effect and optimize medical management model. However, there are still some problems at the present stage in implementation and promotion of patients with hepatolithiasis, such as lacks of criteria and specifications, evidence-based medicine. It is needed to further strengthen communication and collaboration among multiple disciplinary teams so as to further improve ERAS programme and popularize it.
Objective To evaluate the effect of fast track surgery (FTS) after esophageal cancer surgery. Methods The randomized controlled trial (RCT) and observational studies about FTS for esophageal cancer in PubMed、EMbase、The Cochrane Library、Web of Science、CBM、CNKI and WanFang databases were searched up to May 2017. Then the studies were screened according to the inclusion and exclusion criteria by two researchers. Data were analyzed by Stata12.0 software. Results Totally 13 RCTs and 5 observational studies with 2 447 patients were eligible for analysis. Compared with the control group, incidence of postoperative complications (OR=0.53, 95%CI 0.40 to 0.71, P<0.05) significantly reduced in the FTS group, but there was no significant difference between the two groups in readmission rate (OR=1.21, 95%CI 0.83 to 1.76, P=0.313) and 30 d mortality rate (OR=0.72, 95%CI 0.43 to 1.20, P=0.207). Conclusion FTS can safely and effectively accelerate the recovery of patients with esophageal cancer and it owns important clinical values.
Objective To evaluate the use of fast track surgery （FTS） in the treatment for cholecystolithiasis combined with calculus of common bile duct （CBD） by combination of laparoscope and duodenoscope. Methods One hundred and twenty patients with cholecystolithiasis combined with calculus of CBD underwent laparoscopic cholecyst-ectomy （LC） and endoscopic retrograde cholangiopancreatography （ERCP） were divided into FTS group （n=55） and conventional group （n=65），which were accepted the perioperative therapy of FTS or conventional therapy，respectively. After operation，the incision pain，nausea and vomiting，infusion time，loss of body weight，out-of-bed time，dieting time，postoperative hospitalization，hospital costs，and complications were compared in two groups. Results Compared with the conventional group，the postoperative infusion time，dieting time，out-of-bed time，and postoperative hospitali-zation were shorter，the incidence rates of pulmonary infection，and urinary systems infection，pancreatitis，nausea and vomiting， and incision pain were lower，the loss of body weight was lower in the FTS group （P＜0.05），but the differences of WBC and serum amylase at 24 h after operation were not significant between the FTS group and conventional group（P＞0.05）. Conclusion The FTS is safe，economic，and effective in the treatment for cholecystolithiasis combined with calculus of CBD by combination of laparoscope and duodenoscope.
Objective To determine if laparoscopic assisted Ivor-Lewis cervical stapled esophagogastrostomy via a minor subaxillary incising enables better perioperative and medium-term outcome than Ivor-Lewis cervical stapled esophagogastrostomy via thorax for middle esophageal carcinoma without intumescent lymphnode of neck. Methods The perioperative and medium-term outcome of a series of 55 patients underwent Ivor-Lewis cervical stapled esophagogas-trostomy via thorax between April 2010 and December 2012 were as a historic cohort (group A, 36 males, 19 females at age of 65±8 years). And 46 patients underwent laparoscopic assisted Ivor-Lewis cervical stapled esophagogastrostomy via a minor subaxillary incising between January 2013 and March 2015 were as a prospective cohort (group B, 31males, 15 females at age of 66±7 years). Perioperative indexes, lymphadenectomy, and result at end of one year following up were compared. Results Compared with group A, there was shorter thoracic operation time (t=5.94, P < 0.05), shorter time of restored anus exhaust (t=2.08, P < 0.05), less pulmonary complication (χ2=3.08, P < 0.05) and less total perioperative complications (χ2=4.30, P < 0.05), shorter postoperative hospital stay (t=3.20, P < 0.05) in the group B. While no statistically significant difference was found between the two group in postoperative morbidity of circulation or digestive and associated with surgical techniques (all P>0.05), lymph node metastasis rate of cervico-thoracic (include cervical paraesophageal) or mediastinum or abdominal cavity (χ2=0.03, 0.15, 0.08, all P>0.05), lymph node ratio (LNR) of cervical thoracic (include cervical paraesophageal) or mediastinum or abdominal cavity (χ2=0.01,0.71, 0.01, all P>0.05), recurrence rate of tumour (χ2=0.04, P>0.05), or survival rate (χ2=0.13, P>0.05) one year after the surgery. Conclusion Laparoscopic assisted Ivor-Lewis cervical stapled esophagogastrostomy via a minor subaxillary incising is a more rational surgery of cervicothoracic and cervical paraesophageal lymph nodes dissection via intrathoracic instead of cervical approach for middle esophageal carcinoma.
Objective To verify the feasibility and effectiveness of the modified fast-track surgery (FTS) in the perioperative period of open liver resection. Methods A prospective randomized controlled trial was carried out in 188 consecutive patients undergoing open liver resection between March and December 2014 in the Department of Liver Surgery of West China Hospital. The modified fast recovery procedure and standard rehabilitation procedure were compared in terms of length of hospital stay after operation, hospitalization cost, complications and readmission rate. Results A total of 188 consecutive patients were enrolled in the trial. The analysis included 87 patients in the modified fast recovery group and 89 in the standard rehabilitation group. Compared with the standard rehabilitation group, the modified fast recovery group had a shorter length of hospital stay [(5.70±1.47)vs. (7.26±1.96) days] and a lower cost [(42.7±6.7)vs. (47.3±12.5) thousand yuan], and the differences were statistically significant (P<0.05). There were 20 complication cases in the modified group and 39 in the standard group with significant difference (P=0.003). There was no significant difference in the rate of readmission between the two groups (P=1.000). Compared with the standard group, patients in the modified group had less pain 8 hours, the 1st and 2nd days after surgery, better postoperative activities of daily living, more initiative cough times and off-bed activity times, longer duration of movement, and earlier bowel recovery and exhausting, and all the above differences were significantly different (P<0.05). Stepwise regression analysis showed that postoperative complications and bowel recovery and exhausting time were independent related factors for postoperative hospital stay (P<0.001). Conclusions Multimodal analgesia-based fast recovery procedure is feasible and effective in the perioperative period of partial hepatectomy. It can shorten the time of hospitalization and reduce the cost of hospitalization.
Objective To explore the clinical efficacy of nursing measures based on the concept of enhanced recovery after surgery (ERAS) for patients undergoing day surgery of inguinal hernia repair. Methods A total of 120 patients scheduled for day surgery of inguinal hernia repair between January and June 2015 were randomized into ERAS group (n=60) and control group (n=60). Patients in the ERAS group received nursing optimized by the idea of ERAS during the perioperative period, while those in the control group received traditional routine nursing intervention. Postoperative visual analogue scale (VAS) scores, adverse responses, early ambulation, influence of pain on patients’ sleep, satisfaction of the patients and prolonged hospital stay rate were analyzed and compared between the two groups. Results VAS scores during hours 0-2, 2-4, 4-8, and 8-12 in the ERAS group were significantly lower than those in the control group (P < 0.05). Between hour 12 and 24, the VAS sco res were not significantly different between the two groups of patients (P > 0.05). Early postoperative ambulation, influence of pain on the sleep, and patients’ satisfaction on pain control and nursing care in the ERAS group were all significantly better than those in the control group (P <0.05). Conclusion Based on the concept of ERAS nursing intervention model, we can effectively reduce postoperative complications after inguinal hernia repair, accelerate patients’ postoperative rehabilitation, and increase patients’ satisfaction.