Madan Shivakumar, Sureshkumar Sathasivam, Anandhi Amaranathan, Gurushankari Balakrishnan, Keerthi Andi Rajendharan, Palanivel Chinnakali, Kundra Pankaj, Kate Vikram
Departments of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
Cancer Institute Womens' Indian Association (WIA), Chennai, India.
J Gastrointest Surg. 2023 Nov;27(11):2667-2675. doi: 10.1007/s11605-023-05803-9. Epub 2023 Aug 24.
Practices such as prolonged preoperative fasting, bowel preparation, delayed ambulation and resumption of orals result in morbidity in 15-20% of stoma reversal cases which can be improved by Enhanced Recovery After Surgery (ERAS) pathways.
To evaluate the safety, feasibility and efficacy of ERAS pathway in patients undergoing elective loop ileostomy or colostomy reversal surgery METHODS: This was an open-labeled, superiority randomized controlled trial in which patients undergoing loop ileostomy or colostomy reversal were randomized to standard or ERAS care. Patients with ASA class ≥3, needing laparotomy for stoma reversal, cardiac, renal and neurological illnesses were excluded. Components of ERAS protocol included pre-operative carbohydrate loading, avoidance of mechanical bowel preparation, goal directed fluid therapy, avoidance of long-acting opioid anesthetics or analgesics, avoidance of drains, urinary catheter or nasogastric tube, early mobilization and early enteral feeding. The primary outcome was length of stay (LOS) while the secondary outcomes were postoperative recovery and morbidity parameters.
Forty patients each were randomized to standard care and ERAS. Demographic and laboratory parameters between the two groups were comparable. ERAS group patients had significantly reduced LOS (5.3 ± 0.3 vs 7 ± 2.6; mean difference: 1.73 ± 0.98; p=0.0008). Functional recovery was earlier in the ERAS group compared to the standard care group, such as early resolution of ileus (median-2 days; p<0.001), time to first stool (median-3 days; p=0.0002), time to the resumption of liquid diet (median-3 days; p<0.001) and solid diet (median-4 days; p<0.001). Surgical site infections (SSI) were significantly lesser in ERAS group (12.5% vs 32.5%; p=0.03) while postoperative nausea/vomiting (p=0.08), pulmonary complications (p=0.17) and urinary tract infections (p=0.56) were comparable in both groups.
ERAS pathways are feasible, safe and significantly reduces LOS in patients undergoing elective loop ileostomy or colostomy reversal surgery.
诸如术前长时间禁食、肠道准备、延迟下床活动和恢复经口进食等做法，会导致15%至20%的造口回纳病例出现并发症，而手术加速康复（ERAS）方案可改善这些情况。
评估ERAS方案在接受择期袢式回肠造口术或结肠造口回纳手术患者中的安全性、可行性和有效性。
这是一项开放标签的优效性随机对照试验，将接受袢式回肠造口术或结肠造口回纳手术的患者随机分为标准治疗组或ERAS治疗组。排除美国麻醉医师协会（ASA）分级≥3级、需要剖腹进行造口回纳手术、患有心脏、肾脏和神经系统疾病的患者。ERAS方案的组成部分包括术前碳水化合物负荷、避免机械性肠道准备、目标导向性液体治疗、避免使用长效阿片类麻醉剂或镇痛药、避免放置引流管、导尿管或鼻胃管、早期活动和早期肠内营养。主要结局指标是住院时间（LOS），次要结局指标是术后恢复情况和并发症参数。
每组40例患者被随机分配至标准治疗组和ERAS组。两组之间的人口统计学和实验室参数具有可比性。ERAS组患者的住院时间显著缩短（5.3±0.3天对7±2.6天；平均差值：1.73±0.98；p=0.0008）。与标准治疗组相比，ERAS组的功能恢复更早，例如肠梗阻更早缓解（中位数为2天；p<0.001）、首次排便时间（中位数为3天；p=0.0002）、恢复流食时间（中位数为3天；p<0.001）和固体食物时间（中位数为4天；p<0.001）。ERAS组的手术部位感染（SSI）显著较少（12.5%对32.5%；p=0.03），而两组术后恶心/呕吐（p=0.08）、肺部并发症（p=0.17）和尿路感染（p=0.56）情况相当。
ERAS方案对于接受择期袢式回肠造口术或结肠造口回纳手术的患者是可行、安全的，且能显著缩短住院时间。
