SVV monitoring in laparoscopic liver surgery improves intraoperative outcome, thus enhancing the benefits of the minimally-invasive approach and fast-track protocols.

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The aim of this study was to assess the impact of ERAS approach ("fluid restrictive & drainless") on open liver resections for HCC comparing their outcome with open resections in pre-ERAS period and with laparoscopic surgery. Methods: 207 patients undergoing minor liver resection for HCC were divided into three groups: Group A, open minor resections in pre-ERAS period (95 patients); Group B, laparoscopic ERAS resections (55 patients); Group C, open ERAS resections (57 patients). Results: Blood loss was lower in group C and B compared with group A. Postoperative morbidity was 26.5% in group A, 16.3% in group B and 12.1% in group C (p<0.05). Ascites was less frequent in group B (7.5%) and C (6.2%) compared with group A (12%). Median time for functional recovery in groups B (3 days) and C (3 days) was shorter compared with group A (5 days). Conclusion: The laparoscopic approach was associated with reduced blood loss and postoperative morbidity. In patients who are not candidates to minimally-invasive approach, ERAS management seems to be associated with a reduction in blood loss and postoperative morbidity. Results achieved in this group of patients were more similar to those of laparoscopy than to pre-ERAS open surgery.

Objectives: Clinical studies over the last 10 years have shown that the application of ERAS programmes in patients undergoing major intraabdominal surgery, compared with conventional perioperative treatment, is associated with lower incidence of postoperative complications and shorter length of hospital stay. However, there is limited evidence regarding the results and safety of this practice in special categories of patients such as the elderly or those undergoing emergency surgery. The aim of this study was to determine whether the implementation of an ERAS programme is associated with improved outcome in geriatric patients undergoing elective major intra-abdominal surgery. Methods: All consecutive geriatric and adults patients with an ASA grade 3 undergoing elective major intra-abdominal surgery from Sep. 2010 to Aug. 2015 and treated according to an ERAS regimen were prospectively studied and compared with regard to incidence of postoperative complications, length of hospital stay, number of relaparotomies, readmissions and mortality within 30 days. Descriptive values are expressed as mean as ± SD. Data analysis was done by the use of Fisher's exact test and the Mann-Whitney U-test. The protocol for the study was approved by the Scientific and Ethical Committee of our Hospital. Results: Out of the 78 patients treated according to the ERAS programme, 38 were elderly (group A, mean age 76.8 ± 5.6 years) and 40 were adults (group B, mean age 50.6 ± 11.2 years). The two groups were similar with respect to gender, type of disease and type of surgery. Incidence of major postoperative complications was similar in the two groups (13.1% in group A vs. 5% in group B, p¼0.2). Also, there was no difference between the two groups regarding readmissions, relaparotomies and mortality. However, length of postoperative hospital stay was significantly longer in the elderly (6.9 ± 4.6 vs. 5.4 ± 3.2 days, p<0.05). Conclusion: The results of this study suggest that the application of ERAS programmes in geriatric patients is a safe perioperative practice because it does not add significantly more risk in terms of complications, morbidity and mortality compared to the adults, although it is associated with longer length of postoperative hospital stay.

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