Application value of enhanced recovery after surgery for total laparoscopic uncut Roux-en-Y gastrojejunostomy after distal gastrectomy

Abstract

AIMTo evaluate the safety and feasibility of enhanced recovery after surgery (ERAS) for total laparoscopic uncut Roux-en-Y gastrojejunostomy after distal gastrectomy.METHODSThe clinical data of 42 patients who were divided into an ERAS group (n = 20) and a control group (n = 22) were collected. The observed indicators included operation conditions, postoperative clinical indexes, and postoperative serum stress indexes. Measurement data following a normal distribution are presented as mean ± SD and were analyzed by t-test. Count data were analyzed by χ2 test.RESULTSThe operative time, volume of intraoperative blood loss, and number of patients with conversion to open surgery were not significantly different between the two groups. Postoperative clinical indexes, including the time to initial anal exhaust, time to initial liquid diet intake, time to out-of-bed activity, and duration of hospital stay of patients without complications, were significantly different between the two groups (t = 2.045, 8.685, 2.580, and 4.650, respectively, P < 0.05 for all). However, the time to initial defecation, time to abdominal drainage-tube removal, and the early postoperative complications were not significantly different between the two groups. Regarding postoperative complications, on the first and third days after the operation, the white blood cell count (WBC) and C reactive protein (CRP) and interleukin-6 (IL-6) levels in the ERAS group were significantly lower than those in the control group.CONCLUSIONThe perioperative ERAS program for total laparoscopic uncut Roux-en-Y gastrojejunostomy after distal gastrectomy is safe and effective and should be popularized. Additionally, this program can also reduce the duration of hospital stay and improve the degree of comfort and satisfaction of patients.

Application of enhanced recovery after surgery (ERAS) protocol in radical gastrectomy: a systemic review and meta-analysis

“…A flow diagram of the study selection process is shown in figure 1. A total of 445 studies were initially included but 12 RCTs with a total of 1216 patients were found to be eligible for the final meta-analysis 19 20 28–37. A total of 11 RCTs were published in English, whereas 1 RCT was published in Chinese.…”

“…A random-effects model was used (p<0.00001, I 2 =91%) and there was a significant reduction of the first passage time of defecation in ERAS group compared with the control group (MD=−27.55, 95% CI −47.56 to 7.46, p=0.007) (figure 6). Twelve studies published the first passage time of flatus 19 20 28–30 32–34 37. There was significant heterogeneity among the trials (p<0.00001, I 2 =80%) and a significant reduction for the first passage time of flatus in the ERAS group compared with the control group (MD=−14.36, 95% CI −18.63 to 10.08, p<0.00001) (figure 6).…”

“…There was no significant difference between the two groups (SMD=−0.13, 95% CI−0.32 to 0.05, p=0.15). Nine studies reported the serum level of CRP on postoperative day (POD) 1 and 3 or 4 20 28 30 32 33 35 36. A random-effects model was applied (p=0.0001, I 2 =74% on POD 1; p=0.01, I 2 =60% on POD 3 or 4).…”

“…Meta-analysis has been recognised as an effective statistical tool that provides powerful clinical evidence by reviewing and summarising previously published studies. Two new randomised controlled trials (RCTs)14 20 for ERAS protocol application in radical gastrectomy were recently published and these included a high-quality study,20 and therefore a meta-analysis update was required to reassess the safety and efficiency of ERAS protocol application in radical gastrectomy.…”

Análisis clínico e impacto económico de la implantación de una vía clínica de recuperación intensificada en cirugía bariátrica

“…Se calculó la correlación de Spearman entre coste total y estancia total. El grado de satisfacción del paciente ha sido también relacionado con los programas de recuperación intensificada (186,187).…”