Application of enhanced recovery after surgery in bariatric surgery

Abstract

Objective To investigate the effectiveness and safety of enhanced recovery after surgery (ERAS) in the management of undergoing LSG patients during perioperative management. Methods Prospective study the clinical data of 80 patients undergoing LSG surgery in the Department of Gastrointestinal Surgery of the Affiliated Hospital of Xuzhou Medical University from September 2016 to October 2017. The patients were divided into ERAS group (experimental group, 40 cases), non-ERAS group (control group, 40 cases). The experimental group were managed using ERAS protocol, including psychological status assessment, preoperative fasting 6h, non-diabetic patients were given 250 ml of sugar water 2h before surgery, while diabetic patients received 250 ml saline, after induction of anesthesia NG tube and urine catheter were placed, intraoperative electric heater blanket or heater blower to help maintaining warm condition. Immediately after anesthesia recovery, water intake was allowed, promote early eating, analgesic pump were not used if not on-demand, only used flurbiprofenaxetil analgesia. On the other hand, the control group used the traditional model of management, which is preoperative fasting 12 h, water intake allowed up to 4 h before surgery, one night before surgery, oral laxative for bowel preparation, preoperative gastric tube and catheterization, food intake were only allowed after flatus, often used analgesia pump. The operation information, postoperative recovery, pain score, stress index and nutritional status were recorded. The differences between the two groups were analyzed by t-test and Mann-Whitney test. Classification data were analyzed by Fisher's exact test and Pearson's chi-square test. Results Compared with the control group, the experimental group had shorter length of postoperative hospital stay (3.3±1.2d vs 5.0±2.4d, P<0.05) ,gastric tube indwelling time (0.05±0.2d vs 1.18±0.59d, P<0.05), accelerate postoperative first time food intake (1.73±0.56d vs2.55±0.68d, P<0.05 ), and flatus time (1.88±0.69d vs2.50±0.72d, P<0.05). The degree of postoperative pain lower than the control group (P<0.05), the postoperative white blood cells and neutrophil count levels were lower than those in the control group (P<0.05). On the other hand, postoperative albumin, prealbumin were higher in the experimental group than the control group (P<0.05). Conclusions The management of LSG surgery patients using ERAS protocol can shorten the length of hospital stay and accelerate the recovery of postoperative nutritional status. It is safe and reliable and worth popularizing in practice. Key words: Laparoscopic sleeve gastrectomy; Enhanced recovery after surgery; Nutritional status; Postoperative complications