Enhanced Recovery Open vs Laparoscopic Left Donor Nephrectomy: A Randomized Controlled Trial

Mansour, Ahmed M.; El-Nahas, Ahmed R.; Ali-El-Dein, Bedeir; Denewar, Ahmed Abdelfattah; Abbas, Mohammed; Abdelrahman, Ahmed Fetouh; Eraky, Ibrahim; Shokeir, Ahmed A.

doi:10.1016/j.urology.2017.08.047

Cited by 15 publications

(14 citation statements)

References 26 publications

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“…3 Regarding the operative approach, the observed positive impact of minimally invasive surgery on opioid use is consistent with current literature describing experiences in liver surgery and other subspecialties and emphasizes that these approaches should be utilized whenever possible. [40][41][42] Perhaps more importantly, sub-analysis of only those patients who underwent an open approach determined that the impact of ERILS on the observed decrease in opioid use was retained. Because it is not always possible to use a minimally-invasive approach in complex, often re-operative, oncologic surgery, enhanced recovery strategies (including the use of regional nerve blocks) may be most beneficial in these patients, allowing the exposure necessary to safely and effectively complete the resection while replicating the recovery experience traditionally associated with a limited-incision approach.…”

Section: Discussionmentioning

confidence: 99%

Enhanced recovery in liver surgery decreases postoperative outpatient use of opioids

Lillemoe

Marcus

Day

et al. 2019

Surgery

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Background: Pathways of Enhanced Recovery in Liver Surgery (ERILS) decrease inpatient opioid use, however, there is little existing data regarding their effect on discharge prescriptions and post-discharge opioid intake. Methods: For consecutive patients undergoing liver resection from 2011-2018, clinicopathologic factors were compared between patients exposed to ERILS and traditional pathways. Multivariable analysis was used to determine factors predictive for traditional opioid use at the first postoperative follow-up. The ERILS protocol included opioid-sparing analgesia, goal-directed fluid therapy, early postoperative feeding, and early ambulation. Results: Of 244 cases, 147 ERILS patients were compared to 97 traditional pathway patients. ERILS patients were older (median 57 vs. 52 years, p=0.031) and more frequently had minimally invasive operations (37% vs. 16%, p<0.001), with fewer major complications (2% vs. 9%, p=0.011). ERILS patients were less likely to be discharged with a prescription for traditional opioids (26% vs. 79%, p<0.001) and less likely to require opioids at their first postoperative visit (19% vs. 61%, p<0.001) despite similarly low, patient-reported pain scores (median 2/10 both groups, p=0.500). On multivariable analysis, traditional recovery pathway were associated with traditional opioid use at first follow-up (OR 6.4, 95% CI 3.5-12.1; p<0.001). Conclusions: The implementation of an ERILS pathway with opioid-sparing techniques was associated with decreased postoperative discharge prescriptions for opioids and outpatient opioid use after oncologic liver surgery, while achieving the same level of pain control. For this and other

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Section: Discussionmentioning

confidence: 99%

Enhanced recovery in liver surgery decreases postoperative outpatient use of opioids

Lillemoe

Marcus

Day

et al. 2019

Surgery

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“…Seven studies evaluated pain using a Visual Analogue Scale at various time points (ranging from day 1 to 1 month) postoperatively and demonstrated mixed results. 24,27,[29][30][31]33,34 The Visual Analogue F I G U R E 2 Forest plots for ERAS versus standard of care for laparoscopic live donor nephrectomy. (A) Duration of stay was significantly shorter with ERAS by 0.98 days (95% CI = 0.36-1.60, P = .002, I 2 = 94%).…”

Section: Painmentioning

confidence: 99%

“…Clavien-Dindo classifications of complications were included in only one study. 33,36 3.9 | Procedure type…”

Section: Complicationsmentioning

confidence: 99%

A systematic review of living kidney donor enhanced recovery after surgery

Byrne

Mehmood

Summers

et al. 2021

Clinical Transplantation

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Enhanced recovery after surgery (ERAS) reduces complications and shortens hospital stay without increasing readmission or mortality. However, its role in living donor nephrectomy (LDN) has not yet been defined. Medline, Embase, CINAHL, PsycINFO, and Cochrane Central were searched prior to 08/01/21 for all randomized controlled and cohort studies comparing ERAS to standard of care in LDN. The study was registered on PROSPERO (CRD: CRD42019141706). One thousand, three hundred seventy-seven patients were identified from 14 studies (698 patients with ERAS and 679 patients without). There were considerable differences in the protocols used, and compliance with general ERAS recommendations was poor. Meta-analysis of laparoscopic procedures (including hand-and robot-assisted) revealed that duration of stay was significantly reduced by 0.98 days with ERAS (95% CI = 0.36-1.60, P = .002) and opiate requirement by 32.4 mg (95% CI = 1.1-63.7, P = .04). There was no significant difference n readmission rates or complications. Quality of evidence was low to moderate assessed using the GRADE tool. This review suggests there is a positive benefit of ERAS in laparoscopic LDN. However, there was considerable variation in ERAS protocols used, and the quality of evidence was low; as such, a guideline for ERAS in LDN should be developed and validated.

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“…LLDN is as safe as OLDN regarding donor and graft survival, rejection, and urological complications in addition to the superior results in terms of shorter hospital stay and time to return to work, and less intraoperative blood loss [ 22 ]. The risk of end-stage renal disease and survival rate of kidney donors, are similar to those in general population with consistent donor satisfaction.…”

Section: Guidelinesmentioning

confidence: 99%

Egyptian clinical practice guideline for kidney transplantation

Shokeir

Hassan

Shehab

et al. 2021

Arab Journal of Urology

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Objective : To present the first Egyptian clinical practice guideline for kidney transplantation (KT). Methods : A panel of multidisciplinary subspecialties related to KT prepared this document. The sources of information included updates of six international guidelines, and review of several relevant international and Egyptian publications. All statements were graded according to the strength of clinical practice recommendation and the level of evidence. All recommendations were discussed by the panel members who represented most of the licensed Egyptian centres practicing KT. Results : Recommendations were given on preparation, surgical techniques and surgical complications of both donors and recipients. A special emphasis was made on the recipient’s journey with immunosuppression. It starts with setting the scene by covering the donor and recipient evaluations, medicolegal requirements, recipient’s protective vaccines, and risk assessment. It spans desensitisation and induction strategies to surgical approach and potential complications, options of maintenance immunosuppression, updated treatment of acute rejection and chemoprophylactic protocols. It ends with monitoring for potential complications of the recipient’s suppressed immunity and the short- and long-term complications of immunosuppressive drugs. It highlights the importance of individualisation of immunosuppression strategies consistent with pre-KT risk assessment. It emphasises the all-important role of anti-human leucocyte antigen antibodies, particularly the donor-specific antibodies (DSAs), in acute and chronic rejection, and eventual graft and patient survival. It addresses the place of DSAs across the recipient’s journey with his/her gift of life. Conclusion : This guideline introduces the first proposed standard of good clinical practice in the field of KT in Egypt. Abbreviations : Ab: antibody; ABMR: Ab-mediated rejection; ABO: ABO blood groups; BKV: BK polyomavirus; BMI: body mass index; BTS: British Transplantation Society; CAN: chronic allograft nephropathy; CDC: complement-dependent cytotoxicity; CKD: chronic kidney disease; CMV: cytomegalovirus; CNI: calcineurin inhibitor; CPRA: Calculated Panel Reactive Antibodies; (dn)DSA: ( de novo ) donor-specific antibodies; ECG: electrocardiogram; ESWL: extracorporeal shockwave lithotripsy; FCM: flow cytometry; GBM: glomerular basement membrane; GN: glomerulonephritis; HIV: human immunodeficiency virus; HLA: human leucocyte antigen; HPV: human papilloma virus; IL2-RA: interleukin-2 receptor antagonist; IVIg: intravenous immunoglobulin; KT(C)(R): kidney transplantation/transplant (candidate) (recipient); (L)(O)LDN: (laparoscopic) (open) live-donor nephrectomy; MBD: metabolic bone disease; MCS: Mean channel shift (in FCM-XM); MFI: mean fluorescence intensity; MMF: mycophenolate mofetil; mTOR(i): mammalian target of rapamycin (inhibitor); NG: ‘n...

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Enhanced Recovery Open vs Laparoscopic Left Donor Nephrectomy: A Randomized Controlled Trial

Cited by 15 publications

References 26 publications

Enhanced recovery in liver surgery decreases postoperative outpatient use of opioids

Enhanced recovery in liver surgery decreases postoperative outpatient use of opioids

A systematic review of living kidney donor enhanced recovery after surgery

Egyptian clinical practice guideline for kidney transplantation

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