Yoshihito Shinohara, MD. Teinekeijinkai Medical Center
Background: Several studies have shown that, when compared with a conventional perioperative care, Enhanced recovery after surgery (ERAS) pathway was associated with a reduction in the length of hospital stay and rates of complication. Whether such a program is a feasible and beneficial in the setting of emergency ulcer surgery remains unknown.
Methods: This single-center, retrospective case-series study. From January 2005 to April 2017, 98 patients with Perforated Duodenal Ulcer (PDU) underwent laparoscopic repair with simple closure with omentopexy or Graham patch repair. Patients who underwent open surgical repair or standard care were excluded. The Primary outcomes were the length of hospital stay (LOS), morbidity and mortality within 30 days after surgery. The secondary outcomes measured included various functional recovery parameter as individual components of the ERAS protocol. Data were collected retrospectively to assess the efficacy of the ERAS protocol and included all patients undergoing LR. All data analysis
Results: A total of 110 patients were diagnosed with PDU during the study period. 98 patients were initially performed laparoscopic approach. 88 patients (90%) performed laparoscopic repair (LR). LR included laparoscopic simple suture repair with omentopexy (n=73) and Graham omental patch (n=15). 82 patients were adapted ERAS pathway. The reasons for non-adaptation to 6 patients (6%), the required vasopressor for intraoperative shock (n=1), the required ventilator for respiratory failure (n=1), elderly patient with large perforation (n=1), delirium immediately after operation (n=2), and ileus (n=1). Median of LOS was 4 days (quartile range: 4 -5). There was no 30-d mortality and readmission. There was one case above grade3 of the Clavien-Dindo classification because of leakage with percutaneous drainage. There was no reoperation. Median of solid diet was 2 days (quartile range: 2 -2). The overall compliance of ERAS protocol was 61% (50 cases). The variances show in Table 4 which of the prolong of NPO (n=15:NG tube n=5, pain and abdominal distension n=5, suspect of leakage n=4), prolong of LOS (n=13: delayed diet n=4, SSI n=1, patients hope n=1, no known reasons n=7), and delayed drain removing (n=2: suspect of abscess n=2).
Conclusions: In conclusion, ERAS pathways seem safe and feasible for patients undergoing LGPR for PDU. In addition, ERSA pathway with LGPR for PDU make it possible to improve the early oral intake and discharge. It may be possible to early return to society for patients and to reduce health care costs.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92088
Program Number: P023
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster