The application of the concept of accelerated rehabilitation surgery in the perioperative period of laparoscopic esophageal hiatal hernia repair and gastric fundus folding

Abstract

Object To assess the clinical effect and safety of enhanced recovery after surgery(ERAS) approach used in patients with Hiatus hernia . Methods 102 patients with Hiatal hernia who underwent laparoscopic hiatal hernia repair with 360 ° fundoplication were selected and randomly divided into two groups:50 cases in ERAS group and 52 cases in control group. The control group was treated by traditional perioperative method.The ERAS group was treated by ERAS under the guidance of a new type of perioperative treatment.First exhaust and defecation time,leaving bed time,adverse reactions,antibiotics consumption,hospitalization time and complications were compared between the two groups. Results For patients in ERAS group, The length of operation showed no significant difference, however, the intraoperative fluid administered was significantly less in ERAS group(P＜0.05). The ERAS group revealed significantly earlier in the time to remove nasogastric tube, time to withdraw abdominal drainage tube and time to take the first diet and a shorter length of hospital stay（P＜0.05）. Although the total postoperative complications were lower in ERAS group, the incidence of postoperative ventosity and nausea had no difference each other.We made a postoperative telephone follow-up(6 months to 3 years), there was a recurrence two months after discharge in control group and zero in ERAS group, which had no difference between two groups. One cases in the ERAS group had a feeling of choking when taking solid diets,but the symptom disappeared after 3 months. As for the recurrence one in control group, who was improved and discharged after conservative treatment. Conclusion The application of ERAS to the perioperativeperiod of esophageal hiatal hernia is safe and effective. Key words: enhanced recovery after surgery; hiatal hernia