The introduction of enhanced recovery after surgery in LLR

Shingo Ishida, Masayasu Aikawa, Santosh Shrestha, Takuya Katou, Katsuya Okada, Yukihiro Watanabe, Kojun Okamoto, Hiroshi Satou, Mitsuo Miyazawa, Shinichi Sakuramoto, Shigeki Yamaguchi, Isamu Koyama. saitama medical university international medical center

Objective: Laparoscopic liver resection (LLR) is a rapidly spreading in recent years, however, there is not an obvious evidence yet that it is minimal invasive. In this study, we have introduced the Enhanced Recovery After Surgery (ERAS) in the LLR cases and evaluated the possibility and the safety.

Method: Of the 170 LLR cases we have performed in our institution from January 2008 to July 2015, 5 cases were included in ERAS program as an approved study. The conditions for the participation in this study was set to be, a scheduled laparoscopic partial hepatectomy , an expected operation time of less than 4 hours, without serious complications , under 80 years of age, and the consent of the study obtained. The outline of the program is, performing LLR under general anesthesia without epidural block, standing at the bedside in 3 hours, and drinking water in 4 hours after operation, starting liquid diet in the evening of the operative day. In addition to the background of the patients, operative duration, volume of blood loss, post-operative pain, post-operative level of consciousness, post-operative complications, and hospital stay were the parameters included for evaluation. These parameters were compared between the cases that could continue the program and the cases that were dropped from the program.

Result: Of the 5 cases, 2 cases were dropped from the program because they failed to stand at the bedside in 3 hours after operation. Both of the cases were older than 75 years of age. There was no trouble due to the participation to the program. As far as the three cases that could complete the program are concerned, there was no significant difference in peri-operative factors, in comparison to other LLR performed in our institution. However, there was a tendency of a shorter hospital stay.

Conclusion: It was suggested that ERAS could be introduced in LLR safely, and could shorten the hospital stay if we set up a selection criteria such as age.

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