Application of enhanced recovery after surgery conception in selective laparoscopic cholecystectomy: a prospective, randomized, controlled clinical study_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

柔孜麦麦提·艾则孜 ¹ , 阿卜力皮孜·阿卜力克木 ¹ , 阿卜来提·图尔荪 ¹ , 阿卜杜巴柯·伊德日斯巴柯 ¹ , 阿迪力江·阿不力克木 ¹ , 艾克拜尔·尔肯 ¹ , WANG Li ¹ , MA Xiuying ² , DI Liang ³ , ZHAO Xiaofei ³ , DING Jing ³ ,  合贝尔江·力提甫 ¹ ,  ZENG Daobing ³

1. Department of Hepatobiliary Gastrointestinal Surgery, Hetian Regional People’s Hospital, Hetian, Xinjiang 848000, P. R. China;
2. Department of Anesthesioloy, Hetian Regional People’s Hospital, Hetian, Xinjiang 848000, P. R. China;
3. Department of General Surgery, Beijing Youan Hospital, Capital Medical University, Beijing 100069, P. R. China;

Corresponding author：

合贝尔江·力提甫, Email: tulpar3280@163.com; ZENG Daobing, Email: dao_zeng@aliyun.com

Keywords：

enhanced recovery after surgery; laparoscopic cholecystectomy; randomized controlled trial

DOI：

10.7507/1007-9424.202004053

Video：

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Objective To investigate the socioeconomic benefits of enhanced recovery after surgery (ERAS) in perioperative period of selective laparoscopic cholecystectomy (LC) by prospective, randomized, controlled clinical study.Methods A total of 90 patients were recruited in the Hetian Regional People’s Hospital from November 1, 2019 to December 25, 2019. PASS 11 software was used to calculate the sample size. They were grouped into an ERAS group and a tradition group by 1∶1 by random digital table. The patients in the ERAS and the tradition groups were treated with ERAS conception and traditional method respectively during the perioperative period. The postoperative hospitalization time, the first feeding time, the first getting out of bed time, and the first anal exhaust time after operation; the total hospitalization costs, intraoperative infusion, and postoperative total infusion; the intraoperative anesthesia intubation method, trocar layout, and operation time; the pain points of 6 h,12 h and 24 h after operation; the nausea and vomiting after operation; complications and re-hospitalization rate within 30 d after operation were compared between two groups.Results A total of 86 patients finally were included in the study, including 44 cases in the ERAS group and 42 cases in the tradition group. The basic data such as the gender, age, body mass index, etiology, blood routine, liver and kidney functions, etc. between the two groups were not statistically significant (P>0.05). Between the two groups, there were no significant differences in the intraoperative anesthesia intubation method, trocar layout, and operation time (P>0.05). Compared with the tradition group, the hospitalization time, the first feeding time, the first getting out of bed time, and the first anal exhaust time after operation were shorter (P<0.05); the total hospitalization costs, intraoperative infusion, and postoperative total infusion were less (P<0.05); the pain points of 6 h,12 h and 24 h after operation were lower (P<0.05); and the times of nausea and vomiting after operation were less (P<0.05) in the ERAS group. There were no complications such as the intraperitoneal bleeding, biliary leakage, and infection after operation, and no re-hospitalized patients within 30 d in both groups.Conclusion Application of ERAS conception in selective LC perioperative period in Hetian Regional People’s Hospital of Xinjiang Uygur Autonomous Region cannot only shorten postoperative hospitalization time, reduce costs of hospitalization, help to overcome poverty, but also reduce occurrence of complications such as pain, nausea and vomiting, etc.

Citation： WANG Li, MA Xiuying, DI Liang, ZHAO Xiaofei, DING Jing, ZENG Daobing. Application of enhanced recovery after surgery conception in selective laparoscopic cholecystectomy: a prospective, randomized, controlled clinical study. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(11): 1385-1391. doi: 10.7507/1007-9424.202004053 Copy

1.	Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
2.	Loop T. Fast track in thoracic surgery and anaesthesia: update of concepts. Curr Opin Anaesthesiol, 2016, 29(1): 20-25.
3.	Maempel JF, Walmsley PJ. Enhanced recovery programmes can reduce length of stay after total knee replacement without sacrificing functional outcome at one year. Ann R Coll Surg Engl, 2015, 97(8): 563-567.
4.	Aniskevich S, Pai SL. Fast track anesthesia for liver transplantation: review of the current practice. World J Hepatol, 2015, 7(20): 2303-2308.
5.	Williamsson C, Karlsson N, Sturesson C, et al. Impact of a fast-track surgery programme for pancreaticoduodenectomy. Br J Surg, 2015, 102(9): 1133-1141.
6.	Brown JK, Singh K, Dumitru R, et al. The benefits of enhanced recovery after surgery programs and their application in cardiothoracic surgery. Methodist Debakey Cardiovasc J, 2018, 14(2): 77-88.
7.	Bona S, Molteni M, Rosati R, et al. Introducing an enhanced recovery after surgery program in colorectal surgery: a single center experience. World J Gastroenterol, 2014, 20(46): 17578-17587.
8.	Di Rollo D, Mohammed A, Rawlinson A, et al. Enhanced recovery protocols in urological surgery: a systematic review. Can J Urol, 2015, 22(3): 7817-7823.
9.	李乐, 陈金明, 刘中华, 等. 优化加速康复方案在腹腔镜胆囊切除术中的应用. 中华肝脏外科手术学电子杂志, 2018, 7(5): 380-384.
10.	Udayasankar M, Udupi S, Shenoy A. Comparison of perioperative patient comfort with ‘enhanced recovery after surgery (ERAS) approach’ versus ‘traditional approach’ for elective laparoscopic cholecystectomy. Indian J Anaesth, 2020, 64(4): 316-321.
11.	Yeh A, Butler G, Strotmeyer S, et al. ERAS protocol for pediatric laparoscopic cholecystectomy promotes safe and early discharge. J Pediatr Surg, 2020, 55(1): 96-100.
12.	Zhong JX, Kang K, Shu XL. Effect of nutritional support on clinical outcomes in perioperative malnourished patients: a meta-analysis. Asia Pac J Clin Nutr, 2015, 24(3): 367-378.
13.	Sun Z, Kong XJ, Jing X, et al. Nutritional Risk Screening 2002 as a predictor of postoperative outcomes in patients undergoing abdominal surgery: a systematic review and meta-analysis of prospective cohort studies. PLoS One, 2015, 10(7): e0132857.
14.	Smith I, Kranke P, Murat I, et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol, 2011, 28(8): 556-569.
15.	Schricker T, Lattermann R. Perioperative catabolism. Can J Anaesth, 2015, 62(2): 182-193.
16.	McLeod R, Fitzgerald W, Sarr M, et al. Canadian Association of General Surgeons and American College of Surgeons Evidence Based Reviews in Surgery. 14. Preoperative fasting for adults to prevent perioperative complications. Can J Surg, 2005, 48(5): 409-411.
17.	Tamura T, Yatabe T, Kitagawa H, et al. Oral carbohydrate loading with 18% carbohydrate beverage alleviates insulin resistance. Asia Pac J Clin Nutr, 2013, 22(1): 48-53.
18.	杨东杰, 何伟玲, 张晟, 等. 快速康复外科促进结直肠癌患者术后康复及胰岛素敏感性恢复的前瞻性随机对照研究. 中华外科杂志, 2012, 50(10): 870-874.
19.	Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate therapy. Curr Opin Anaesthesiol, 2015, 28: 364-369.
20.	Bilku DK, Dennison AR, Hall TC, et al. Role of preoperative carbohydrate loading: a systematic review. Ann R Coll Surg Engl, 2014, 96(1): 15-22.
21.	中国医师协会外科医师分会胆道外科医师委员会. 胆道手术加速康复外科专家共识 (2016 版). 中华消化外科杂志, 2017, 16(1): 6-13.
22.	中华医学会外科学分会外科手术学学组, 中国医疗保健国际交流促进会, 加速康复外科学分会肝脏外科学组. 肝切除术后加速康复中国专家共识 (2017 版). 临床肝胆病杂志, 2017, 33(10): 1876-1882.
23.	Keulemans Y, Eshuis J, de Haes H, et al. Laparoscopic cholecystectomy: day-care versus clinical observation. Ann Surg, 1998, 228(6): 734-740.
24.	Parvaiz MA, Hafeez R. Randomized clinical trial of day-care versus overnight-stay laparoscopic cholecystectomy (Br J Surg 2006; 93: 40-45). Br J Surg, 2006, 93(5): 639-640.
25.	Gan TJ, Meyer T, Apfel CC, et al. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg, 2003, 97(1): 62-71.
26.	Balzano G, Zerbi A, Braga M, et al. Fast-track recovery programme after pancreatico-duodenectomy reduces delayed gastric emptying. Br J Surg, 2008, 95(11): 1387-1393.
27.	中国加速康复外科专家组. 中国加速康复外科围术期管理专家共识 (2016 版). 中华消化外科杂志, 2016, 15(6): 527-533.
28.	Tan M, Law LS, Gan TJ. Optimizing pain management to facilitate enhanced recovery after surgery pathways. Can J Anaesth, 2015, 62(2): 203-218.
29.	Vadivelu N, Mitra S, Schermer E, et al. Preventive analgesia for postoperative pain control: a broader concept. Local Reg Anesth, 2014, 7: 17-22.
30.	Abdul Jalil RM, Yahya N, Sulaiman O, et al. Comparing the effectiveness of ropivacaine 0.5% versus ropivacaine 0.2% for transabdominis plane block in providing postoperative analgesia after appendectomy. Acta Anaesthesiol Taiwan, 2014, 52(2): 49-53.
31.	中国研究型医院学会加速康复外科专业委员会, 中国日间手术合作联盟. 胆道外科日间手术规范化流程专家共识 (2018 版). 中华外科杂志, 2018, 56(5): 321-327.
32.	Lassen K, Coolsen MM, Slim K, et al. Guidelines for perioperative care for pancreaticoduodenectomy: enhanced recovery after surgery (ERAS®) society recommendations. Clin Nutr, 2012, 31(6): 817-830.
33.	罗俊, 杨能红, 孙诚谊. 加速康复外科应用于胆囊微创手术的临床观察. 腹部外科, 2017, 30(5): 369-372.

1. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
2. Loop T. Fast track in thoracic surgery and anaesthesia: update of concepts. Curr Opin Anaesthesiol, 2016, 29(1): 20-25.
3. Maempel JF, Walmsley PJ. Enhanced recovery programmes can reduce length of stay after total knee replacement without sacrificing functional outcome at one year. Ann R Coll Surg Engl, 2015, 97(8): 563-567.
4. Aniskevich S, Pai SL. Fast track anesthesia for liver transplantation: review of the current practice. World J Hepatol, 2015, 7(20): 2303-2308.
5. Williamsson C, Karlsson N, Sturesson C, et al. Impact of a fast-track surgery programme for pancreaticoduodenectomy. Br J Surg, 2015, 102(9): 1133-1141.
6. Brown JK, Singh K, Dumitru R, et al. The benefits of enhanced recovery after surgery programs and their application in cardiothoracic surgery. Methodist Debakey Cardiovasc J, 2018, 14(2): 77-88.
7. Bona S, Molteni M, Rosati R, et al. Introducing an enhanced recovery after surgery program in colorectal surgery: a single center experience. World J Gastroenterol, 2014, 20(46): 17578-17587.
8. Di Rollo D, Mohammed A, Rawlinson A, et al. Enhanced recovery protocols in urological surgery: a systematic review. Can J Urol, 2015, 22(3): 7817-7823.
9. 李乐, 陈金明, 刘中华, 等. 优化加速康复方案在腹腔镜胆囊切除术中的应用. 中华肝脏外科手术学电子杂志, 2018, 7(5): 380-384.
10. Udayasankar M, Udupi S, Shenoy A. Comparison of perioperative patient comfort with ‘enhanced recovery after surgery (ERAS) approach’ versus ‘traditional approach’ for elective laparoscopic cholecystectomy. Indian J Anaesth, 2020, 64(4): 316-321.
11. Yeh A, Butler G, Strotmeyer S, et al. ERAS protocol for pediatric laparoscopic cholecystectomy promotes safe and early discharge. J Pediatr Surg, 2020, 55(1): 96-100.
12. Zhong JX, Kang K, Shu XL. Effect of nutritional support on clinical outcomes in perioperative malnourished patients: a meta-analysis. Asia Pac J Clin Nutr, 2015, 24(3): 367-378.
13. Sun Z, Kong XJ, Jing X, et al. Nutritional Risk Screening 2002 as a predictor of postoperative outcomes in patients undergoing abdominal surgery: a systematic review and meta-analysis of prospective cohort studies. PLoS One, 2015, 10(7): e0132857.
14. Smith I, Kranke P, Murat I, et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol, 2011, 28(8): 556-569.
15. Schricker T, Lattermann R. Perioperative catabolism. Can J Anaesth, 2015, 62(2): 182-193.
16. McLeod R, Fitzgerald W, Sarr M, et al. Canadian Association of General Surgeons and American College of Surgeons Evidence Based Reviews in Surgery. 14. Preoperative fasting for adults to prevent perioperative complications. Can J Surg, 2005, 48(5): 409-411.
17. Tamura T, Yatabe T, Kitagawa H, et al. Oral carbohydrate loading with 18% carbohydrate beverage alleviates insulin resistance. Asia Pac J Clin Nutr, 2013, 22(1): 48-53.
18. 杨东杰, 何伟玲, 张晟, 等. 快速康复外科促进结直肠癌患者术后康复及胰岛素敏感性恢复的前瞻性随机对照研究. 中华外科杂志, 2012, 50(10): 870-874.
19. Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate therapy. Curr Opin Anaesthesiol, 2015, 28: 364-369.
20. Bilku DK, Dennison AR, Hall TC, et al. Role of preoperative carbohydrate loading: a systematic review. Ann R Coll Surg Engl, 2014, 96(1): 15-22.
21. 中国医师协会外科医师分会胆道外科医师委员会. 胆道手术加速康复外科专家共识 (2016 版). 中华消化外科杂志, 2017, 16(1): 6-13.
22. 中华医学会外科学分会外科手术学学组, 中国医疗保健国际交流促进会, 加速康复外科学分会肝脏外科学组. 肝切除术后加速康复中国专家共识 (2017 版). 临床肝胆病杂志, 2017, 33(10): 1876-1882.
23. Keulemans Y, Eshuis J, de Haes H, et al. Laparoscopic cholecystectomy: day-care versus clinical observation. Ann Surg, 1998, 228(6): 734-740.
24. Parvaiz MA, Hafeez R. Randomized clinical trial of day-care versus overnight-stay laparoscopic cholecystectomy (Br J Surg 2006; 93: 40-45). Br J Surg, 2006, 93(5): 639-640.
25. Gan TJ, Meyer T, Apfel CC, et al. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg, 2003, 97(1): 62-71.
26. Balzano G, Zerbi A, Braga M, et al. Fast-track recovery programme after pancreatico-duodenectomy reduces delayed gastric emptying. Br J Surg, 2008, 95(11): 1387-1393.
27. 中国加速康复外科专家组. 中国加速康复外科围术期管理专家共识 (2016 版). 中华消化外科杂志, 2016, 15(6): 527-533.
28. Tan M, Law LS, Gan TJ. Optimizing pain management to facilitate enhanced recovery after surgery pathways. Can J Anaesth, 2015, 62(2): 203-218.
29. Vadivelu N, Mitra S, Schermer E, et al. Preventive analgesia for postoperative pain control: a broader concept. Local Reg Anesth, 2014, 7: 17-22.
30. Abdul Jalil RM, Yahya N, Sulaiman O, et al. Comparing the effectiveness of ropivacaine 0.5% versus ropivacaine 0.2% for transabdominis plane block in providing postoperative analgesia after appendectomy. Acta Anaesthesiol Taiwan, 2014, 52(2): 49-53.
31. 中国研究型医院学会加速康复外科专业委员会, 中国日间手术合作联盟. 胆道外科日间手术规范化流程专家共识 (2018 版). 中华外科杂志, 2018, 56(5): 321-327.
32. Lassen K, Coolsen MM, Slim K, et al. Guidelines for perioperative care for pancreaticoduodenectomy: enhanced recovery after surgery (ERAS®) society recommendations. Clin Nutr, 2012, 31(6): 817-830.
33. 罗俊, 杨能红, 孙诚谊. 加速康复外科应用于胆囊微创手术的临床观察. 腹部外科, 2017, 30(5): 369-372.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of enhanced recovery after surgery conception in selective laparoscopic cholecystectomy: a prospective, randomized, controlled clinical study

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