Enhanced recovery after laparoscopic cholecystectomy: A single-center experience

Abstract

Background: The role of Eintraoperative joint organ removal or transit abdominal surgery recovery after surgery (ERAS) in reducing hospital stay time and perioperative hospitalization costs have been proven. However, most studies have been carried out in areas rich in medical resources. In this study, we evaluated the safety and efficacy of ERAS compared with traditional perioperative period care for laparoscopic cholecystectomy (LC) in areas poor in medical resources in China. Methods: A randomized controlled trial on laparoscopic cholecystectomy was conducted at The People's Hospital of Fengqing from July 2020 to March 2021. Patients were randomly divided into an ERAS group and a traditional care group. The main outcome was the length of hospital stay after surgery. The secondary outcomes included hospitalization costs and visual analogue scale (VAS) scores for postoperative pain, first exhaust time, and first semi-liquid diet time after surgery. The ERAS group was provided with perioperative education, nutritional support, preoperative 2 h oral carbohydrates, restricted rehydration, intraoperative insulation, no drainage tubes, wound hemp, early mobilization postoperative nausea and vomiting (PONV) prevention and multi-modal analgesia, early activity. Results: The study was conducted on a total of 140 patients with 70 patients each in the ERAS group and traditional care groups. In the ERAS group, The length of hospital stay after surgery was shorter (4.06 vs.4.61 days, P<0.05), the average hospitalization cost (CNY 7900 vs. 8470, P<0.05),and VAS score (3.10 vs. 3.57 points, compared to the eraser group P<0.001) was lower, the first exhaust time was shorter (12.2 vs. 14.2 hours, P<0.001), the first semi-liquid diet time after surgery was shorter(14.5 vs. 16.8 hours, P<0.001), and the incidence of major postoperative complications was lower (bile leakage, postoperative bleeding, bile duct damage) (0% vs. 12.9%, P<0.05). No significant difference in surgery time (57.8 vs. 54.6 min, P>0.05) was observed between the two groups. Conclusion:Even in areas poor in medical resources in China, the use of the ERAS concept for LC surgery can reduce the length of hospital stay, cut down the cost of hospitalization, and lessen the pain of patients after surgery and accelerate postoperative recovery.