Effect of Fast-Track Surgery under ERAS protocol in Laparoscopic Hysterectomy: A Randomized Controlled Trial

Abstract

Background and Objective: Fast-track surgery (FTS) consists of different pathways to decrease surgical complications and improve outcomes and patient satisfaction. FTS in an elective gynecologic laparoscopic surgery has not been well assessed. No consensus guidelines have been developed for gynecologic laparoscopic surgeries. The purpose of this study is to evaluate enhanced recovery after surgery (ERAS) for total laparoscopic hysterectomy. Methods: 260 patients underwent for laparoscopic hysterectomy surgery. All patients were divided into two groups as follows: one group received traditional laparoscopic hysterectomy surgery and the intervention group was treated under ERAS protocol. ERAS protocol includes not receiving preoperative mechanical bowel preparation and laxatives as well as fasting 6 h and not drinking liquids 2h before surgery. The patients were allowed to resume the ordinary diet 6h post-operation. Ondansetron 4 mg were prescribed after surgery for nausea and vomiting, pain was controlled with non-narcotic analgesics diclofenac suppository 100 mg/q12 h and paracetamol 1000 mg/q6 h until discharge. Urinary catheter was removed whenever possible and early ambulation occurred 6h after the surgery. Results: A total of 260 patients were studied. Regarding the length of hospitalization, significant differences were shown between the groups (P<0.001). Return to daily functions was occurred earlier in the fast-track surgery group than another group. Complications and VAS pain scores showed no significant differences between the groups. Conclusion: Our results show that ERAS surgery has fewer side effects and better outcomes which make it more suitable for patients undergoing laparoscopic hysterectomy.

Fast-Track surgery protocol in perioperative care for gynecological laparoscopy

“…Current review by Scheib et al indicated that for various types of gynecologic surgeries both FTS and standard care protocol were associated with similar rates of complications. 29 , 30 In our study, FTS was associated with significantly lower incidence of postoperative complications compared to usual care. However, this difference became insignificant when complications were analyzed individually.…”