Enhanced recovery program in hepatobiliary surgery: experimental and clinical assessment

Materials and methods. The experiment was performed on 20 male Chinchilla rabbits. The authors studied the effectiveness of various types of nutritional support in resection of the left lateral lobe of the liver. A comparative analysis was based on the results of treatment of 1275 patients with acute and chronic diseases of the liver and biliary tract, 659 (51.7%) of which corresponded to the Fast Track program, and 616 (48.3%) were the control group.

Results. The duration of inpatient treatment was reduced from 13.4 ± 4.2 to 9.3 ± 3.0 days (t = 2.08; p = 0.04), and hospital mortality decreased from 0.8% to 0.45% (p = 0.12). The postoperative morbidity fell from 4.2% to 3.2%, in particular, the proportion of III–V grade complications (Clavien–Dindo classification) reduced from 48.4% to 19.0% (t = 2.34, p = 0.025).

Conclusion. Clinical implementation of main Fast Track components in the early perioperative period in diseases of the liver and biliary tract reliably optimizes postoperative rehabilitation and reduces the incidence of postoperative complications. First promising results of this program suggest the need to correct traditional stereotypes ingrained in treatment programs for patients with hepatobiliary diseases, in order to improve the results of surgeries.

1. Maessen J., Dautzenberg M.G.H., Machiels E.C.A., Rouflart M.M.J., Dejong Cornelis H.C., Maartenvon Meuenfeldt. Implementation of an enhanced recovery program in colon surgery: Pitfalls. Clin. Nutr. 2003; 22 (1): 105. https://doi.org/10.1016/S0261-5614(03)80393-X

2. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br. J. Anaesth. 1997; 78 (5): 606–617. https://doi.org/10.1093/bja/78.5.606

3. Cavallaro P., Bordeianou L. Implementation of an ERAS pathway in colorectal surgery. Clin. Colon. Rectal Surg. 2019; 32 (2): 102–108. https://doi.org/10.1055/s-0038-1676474

4. Huang Z.D., Gu H.Y., Zhu J., Luo J., Shen X.F., Deng Q.F., Zhang C., Li Y.B. The application of enhanced recovery after surgery for upper gastrointestinal surgery: meta-analysis. BMC Surg. 2020; 20 (1): 3. https://doi.org/10.1186/s12893-019-0669-3

5. Darwin V.V., Onishchenko S.V., Ilkanich A.Ya., Nabiullin I.R. Carcass transhepatic drainage in the surgery of lesions and strictures of extrahepatic bile ducts. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2005; 10 (2): 54. (In Russian)

6. Gustafsson U., Scott M., Schwenk W., Demartines N., Roulin D., Francis N., McNaught C., Macfie J., Liberman A., Soop M., Hill A., Kennedy R., Lobo D., Fearon K., Ljungqvist O. Enhanced Recovery After Surgery (ERAS) Society, for Perioperative Care; European Society for Clinical Nutrition and Metabolism (ESPEN); International Association for Surgical Metabolism and Nutrition (IASMEN). Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World J. Surg. 2013; 37 (2): 259–284. https://doi.org/10.1007/s00268-012-1772-0

7. Schwenk W., Lang I., Huhn M. Strukturelle Implementierungeines Fast-Track-Programms – wiegeht das? [Structured implementation of a fast-track program – how does it work?]. Zentralbl. Chir. 2021; 146 (3): 249–259. https://doi.org/10.1055/a-1385-0357

8. Hajibandeh S., Hajibandeh S., Bill V., Satyadas T. Meta-analysis of Enhanced Recovery After Surgery (ERAS) protocols in emergency abdominal surgery. World J. Surg. 2020; 44 (5): 1336–1348. https://doi.org/10.1007/s00268-019-05357-5

9. Debono B., Corniola M., Pietton R., Sabatier P., Hamel O., Tessitore E. Benefits of Enhanced Recovery after Surgery for fusion in degenerative spine surgery: impact on outcome, length of stay, and patient satisfaction. Neurosurg. Focus. 2019; 46 (4): E6. https://doi.org/10.3171/2019.1.FOCUS18669

10. Dietz N., Sharma M., Adams S., Alhourani A., Ugiliweneza B., Wang D., Nuño M., Drazin D., Boakye M. Enhanced recovery after surgery (ERAS) for spine surgery: a systematic review. World J. Neurosurg. 2019; 130: 415–426. https://doi.org/10.1016/j.wneu.2019.06.181

11. Soffin E.M., Vaishnav A.S., Wetmore D.S., Barber L., Hill P., Gang C.H., Beckman J.D., Albert T.J., Qureshi S.A. Design and implementation of an Enhanced Recovery After Surgery program for minimally invasive lumbar decompression spine surgery: initial experience. Spine (Phila Pa 1976). 2019; 44 (9): E561–E570. https://doi.org/10.1097/BRS.0000000000002905

12. Ni X., Jia D., Guo Y., Sun X., Suo J. The efficacy and safety of Enhanced Recovery After Surgery (ERAS) program in laparoscopic digestive system surgery: a meta-analysis of randomized controlled trials. Int. J. Surg. 2019; 69: 108–115. https://doi.org/10.1016/j.ijsu.2019.07.034

13. Varganova A., Darvin V., Krasnov E., Skalskaya N. Clinical effectiveness of early enteral nutrition in patients with small intestine resection. Georgian Med. News. 2022; 323: 7–11.

14. Seyfried S., Herrle F., Schröter M., Hardt J., Betzler A., Rahbari N.N., Reißfelder C. Erste Erfahrungen in der Umsetzungeines ERAS (“enhanced recovery after surgery”) – Konzepts [Initial experiences with the implementation of the enhanced recovery after surgery (ERAS protocol]. Chirurg. 2021; 92 (5): 428–433. https://doi.org/10.1007/s00104-020-01341-1

15. Ljungqvist O., Gustafsson U.O., Lobo D.N. Early postoperative supplementary parenteral nutrition. JAMA Surg. 2022; 157 (5): 393–394. https://doi.org/10.1001/jamasurg.2022.0266

16. Roulin D., Hubner M., Shirata C., Demartines N. ERAS: perioperative care for the benefit of the patient. Rev. Med. Suisse. 2022; 18 (786): 1218–1222. https://doi.org/10.53738/REVMED.2022.18.786.1218

17. Barbero M., García J., Alonso I., Alonso L., San Antonio-San Román B., Molnar V., León C., Cea M. ERAS protocol compliance impact on functional recovery in colorectal surgery. Cir. Esp. 2021; 99 (2): 108–114. https://doi.org/10.1016/j. ciresp.2020.05.010

18. Baeshko A.A., Klimuk S.A., Yushkevich V.A. Causes and features of lesions of the intestine and its vessels in acute disorder of the mesenteric circulation. Pirogov Russian Journal of Surgery = Khirurgiya. Zhurnal im. N.I. Pirogova. 2005; 4: 57–63. (In Russian)

19. Bagdasarov V.V., Bagdasarova E.A., Atayan A.A. Acute intestinal vascular disorders (acute intestinal ischemia) [Acute vascular diseases of the intestine (acute intestinal ischemia)]. Moscow: I.M. Sechenov First State Medical University, 2014. 17 p.