Bowel surgery in an Enhanced Surgical Recovery Programme (ESRP) for gynaecologic surgery: Is recovery still enhanced or do we need to take a step back?

Abstract

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.