Validation of the Enhanced Recovery after Surgery (ERAS) society recommendations for liver surgery: a prospective, observational study

Twenty-three recommendations were summarized by the Enhanced Recovery After Surgery(ERAS)society for liver surgery.The aim was to validate the protocol especially with regard to adherence and the impact on morbidity.Methods:Using the ERAS Interactive Audit System(EIAS),ERAS items were evaluated in patients undergoing liver resection.Over a period of 26 months,304 patients were prospectively enrolled in an observational study(DRKS00017229).Of those,51 patients(non-ERAS)were enrolled before and 253 patients(ERAS)after the implementation of the ERAS protocol.Perioperative adherence and complications were compared between the two groups.Results:Overall adherence increased from 45.2%in the non-ERAS group to 62.7%in the ERAS group(P<0.001).This was associated with significant improvements in the preoperative and postoperative phase(P<0.001),rather than in the outpatient and intraoperative phase(both P>0.05).Overall complications decreased from 41.2%(n=21)in the non-ERAS group to 26.5%(n=67)in the ERAS group(P=0.0423),which was mainly due to the reduction of grade 1-2 complications from 17.6%(n=9)to 7.6%(n=19)(P=0.0322).As for patients undergoing open surgery,implementation of ERAS lead to a reduction of overall complications in patients scheduled for minimally invasive liver surgery(MILS)(P=0.036).Conclusions:Implementation of the ERAS protocol for liver surgery according to the ERAS guidelines of the ERAS Society reduced Clavien-Dindo grade 1-2 complications particularly in patients who underwent MILS.The ERAS guidelines are beneficial for the outcome,while adherence to the various items has not yet been satisfactorily defined.

A case-control study on early removal of thoracic drainage tube and gastric tube after MIE

Objective To investigate the feasibility and safety of early removal of gastric tube and thoracic drainage tube after minimally invasive esophagectomy.Methods A retrospective analysis was performed on 93 patients undergoing thoraco-laparoscopic assisted esophagectomy between January 2022 and September 2022.All patients were divided into two groups,the early group and the conventional group.The differences in drainage volume on the first day after operation,days of thoracic drainage tube indwelling,thoracic drainage tube replacement,incidence rate of pleural effusion,atelectasis,pneumothorax as well as pulmonary infection,respiratory insufficiency,and postoperative hospital stay were compared between the two groups.The criteria for thoracic drainage tube removal is the daily thoracic drainage volume of less than 250 ml in the early group.The gastric fluid volume on the first day after operation,the number of days of gastric tube indwelling,the rate of gastric tube replacement after removal,and the time of intestinal exhaust were compared between the two groups.In the meantime,the incidence of complications,such as anastomotic leakage and pulmonary infection,was observed in the two groups.Results The removal time of gastric tube and thoracic drainage tube was significantly earlier in the early group than in the control group(P<0.05).There was no significant difference in the gastric fluid volume and pleural fluid between the early group and the conventional group(P>0.05),but there were significant differences in postoperative anastomotic leakage between the two groups(P<0.05).There was no significant difference in the incidence of pleural effusion,atelectasis,pneumothorax,and pulmonary infection(P>0.05),nor in thoracentesis rate and gastric tube replacement(P>0.05).The postoperative hospital stay was significantly shorter in the early group than in the conventional group(P<0.05)Conclusion The early removal of the thoracic drainge tube and gastric tube is safe and effective,which does not increase the incidence of postoperative complications.