Clinical effect and safety of enhanced recovery after surgery in laparoscopic hepatectomy

Objective To investigate the clinical effect and safety of enhanced recovery after surgery ( ERAS) in laparoscopic hepatectomy.Methods A total of 55 patients who underwent laparoscopic hepatectomy in Department of Hepatobiliary Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, from January 2014 to December 2016 were enrolled and randomly divided into ERAS group with 27 patients and control group with 28 patients ( conventional perioperative treatment) . The two groups were compared in terms of recovery of liver function after surgery, C-reactive protein ( CRP) , incidence of postoperative complications, postoperative recovery, postoperative physical recovery score, and quality of life. The independent samples t-test was used for comparison of continuous data between groups, an analysis of variance with repeated measures was used for comparison of change trends of indices between the two groups, and the chi-square test was used for comparison of categorical data between groups. Results There were no significant differences in related indices before and during surgery between the two groups ( all P > 0. 05) . Compared with the control group, the ERAS group had significantly lower aspartate aminotransferase and CRP on day 5 after surgery ( t = 2. 168 and 2. 291, both P < 0. 05) , and there were no significant differences in other liver function parameters between the two groups ( all P > 0. 05) . The ERAS group had significantly lower incidence rates of postoperative non-surgical site complications than the control group ( χ2= 4. 15, P < 0. 05) , and there were no significant differences in the overall incidence of complications, incidence rates of surgical site complications, and the Clavien-Dindo classification of complications between the two groups ( all P > 0. 05) . As for postoperative recovery scores, the ERAS group had significantly better comprehensive score, pain score, and activity score than the control group ( t = 1. 297, 2. 777, and 3. 009, all P < 0. 05) . Compared with the control group, the ERAS group had significantly shorter time to first flatus, time to first defecation, and length of postoperative hospital stay ( t =6. 291, 2. 577, and 4. 229, all P < 0. 05) . Conclusion When applied in patients undergoing laparoscopic hepatectomy, ERAS can reduce surgical stress and incidence of non-surgical site complications and accelerate postoperative recovery.