Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti, 13, Bologna 40138, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Govoni, Raimondo, Palermo, Casadio, and Seracchioli); Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Cau, Palermo, Seracchioli).
Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti, 13, Bologna 40138, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Govoni, Raimondo, Palermo, Casadio, and Seracchioli); Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Cau, Palermo, Seracchioli).
J Minim Invasive Gynecol. 2024 Jan;31(1):49-56. doi: 10.1016/j.jmig.2023.10.011. Epub 2023 Oct 13.
To assess the impact of implementing an enhanced recovery after surgery (ERAS) protocol on the length of hospitalization in women undergoing laparoscopy for rectosigmoid deep infiltrating endometriosis (DIE).
A retrospective cohort study.
An academic referral center for endometriosis and minimally invasive gynecologic surgery.
Women aged between 18 and 50 years scheduled for laparoscopic excision (shaving, full-thickness anterior wall resection, segmental resection) of rectosigmoid endometriosis between February 2017 and February 2023.
We divided patients into 2 groups (non-ERAS and ERAS) based on the timing of surgery (before or after March 5, 2020). Starting from this day, restrictions were issued to limit the spread of the coronavirus disease 2019 pandemic, inducing our group to implement an ERAS protocol for patients hospitalized after surgery for posterior DIE.
We included 579 patients in the analysis, 316 (54.6%) in the non-ERAS group and 263 (45.4%) in the ERAS group. In the ERAS group, we observed a shorter length of hospital stay (5.8 ± 3.1 days vs 4.8 ± 2.9 days; p <.001) and lower complications rates (33, 12.5% vs 60, 19.0%; p = .04), despite a decreased frequency of conservative surgical approaches (shaving procedures 121 vs 196; p <.001). Repeated surgery or hospital readmissions owing to postdischarge complications were infrequent, with no significant differences between the 2 groups. The multiple linear regression analysis strengthened our results given the higher prevalence of bowel resection surgeries (both full-thickness anterior wall or segmental), showing that patients managed with a multimodal protocol had an overall reduction of hospital stay by 1.5 days.
The implementation of an ERAS program in patients undergoing laparoscopic surgery for DIE is associated with a significant reduction in hospital stay, without an increase in perioperative or postoperative complication rates.
评估实施术后加速康复（ERAS）方案对腹腔镜直肠乙状结肠深部浸润性子宫内膜异位症（DIE）患者住院时间的影响。
回顾性队列研究。
子宫内膜异位症和微创妇科手术的学术转诊中心。
2017 年 2 月至 2023 年 2 月期间，年龄在 18 至 50 岁之间，计划接受腹腔镜下直肠乙状结肠子宫内膜异位症切除术（刮除术、全层前壁切除术、节段切除术）的女性。
我们根据手术时间（2020 年 3 月 5 日之前或之后）将患者分为 2 组（非 ERAS 组和 ERAS 组）。从这一天起，为限制 2019 年冠状病毒病（COVID-19）大流行的传播，我们组对手术后住院的后位 DIE 患者实施了 ERAS 方案。
我们共纳入 579 例患者，非 ERAS 组 316 例（54.6%），ERAS 组 263 例（45.4%）。在 ERAS 组，我们观察到住院时间更短（5.8 ± 3.1 天 vs 4.8 ± 2.9 天；p <.001）和更低的并发症发生率（33 例，12.5% vs 60 例，19.0%；p =.04），尽管保守手术方法的频率降低（刮除术 121 例 vs 196 例；p <.001）。由于出院后并发症再次手术或再次住院的情况很少见，两组之间无显著差异。多线性回归分析加强了我们的结果，因为全层前壁或节段性肠切除术的比例更高，表明采用多模式方案的患者总体住院时间减少了 1.5 天。
在接受腹腔镜 DIE 手术的患者中实施 ERAS 方案可显著缩短住院时间，而不会增加围手术期或术后并发症的发生率。
