Top

Published in:

01-08-2021 | Cholecystitis | Original Article

Modified enhanced recovery after surgery protocol in patients with acute cholecystitis: efficacy, safety and feasibility. Multicenter randomized control study

Authors: Taras Nechay, Svetlana Titkova, Alexander Tyagunov, Mikhail Anurov, Alexander Sazhin

Published in: Updates in Surgery | Issue 4/2021

Abstract

Laparoscopic cholecystectomy (LC) is a common surgical procedure in acute cholecystitis (AC). Patients often suffer from considerable postoperative pain and indigestion, which prolongs in-hospital stay. The enhanced recovery after surgery (ERAS) program has proven its efficacy in elective surgery and could hypothetically improve outcomes of emergency LC. Currently, there is no ERAS program for LC in patients with AC. A modified ERAS (mERAS) protocol was studied in a prospective, randomized non-blinded clinical trial (NCT03754751). The mERAS group consisted of 88 patients the control group of 101 patients. The modified protocol included a patient information brochure; minimizing drain use; local anesthesia; low-pressure pneumoperitoneum; PONV prophylaxis, early mobilization and oral diet. The primary outcome was postoperative length of stay (pLOS). The postoperative length of stay in the mERAS group was shorter (24 (21–45.5) h) than in the control (45 (41–68) h) (p < 0.0001). One re-admission in the mERAS group was reported (p = 0.466). There difference in complications was insignificant (mERAS 6.8% vs 5% p = 0.757). Post-operative pain intensity was significantly lower in the mERAS group immediately after awaking (3.7 ± 1.8 vs 5.4 ± 1.3 p < 0.0001), 2 h (3.3 ± 1.7 vs 4.9 ± 1.6 p = 0.0006), 6 h (2.9 ± 1.5 vs 4.2 ± 1.2 p < 0.0001), 12 h (2.7 ± 0.9 vs 4.1 ± 1.2 p = 0.0001) and 24 h after surgery (2.1 ± 1.2 vs 3 ± 1.2 p < 0.0001). The incidence of shoulder and neck pain was lower in mERAS group (13.6% vs 34.7% p = 0.0009). Peristalsis recovery was similar in both groups. The proposed protocol improved postoperative recovery and reduced hospital stay in patients with AC without increasing the rate of complications or re-admissions.

Stinton LM, Shaffer EA (2012) Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver 6:172–187CrossRefPubMedPubMedCentral

Ansaloni L, Pisano M, Coccolini F et al (2016) 2016 WSES guidelines on acute calculous cholecystitis. World J Emerg Surg. https://doi.org/10.1186/s13017-016-0082-5CrossRefPubMedPubMedCentral

Shaffer EA (2005) Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century? Curr Gastroenterol Rep 7:132–140CrossRefPubMed

Wang H, Naghavi M, Allen C et al (2016) Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388:1459–1544. https://doi.org/10.1016/S0140-6736(16)31012-1CrossRef

Koti RS, Davidson CJ, Davidson BR (2015) Surgical management of acute cholecystitis. Langenbeck’s Arch Surg 400:403–419. https://doi.org/10.1007/s00423-015-1306-yCrossRef

Borzellino G, Khuri S, Pisano M et al (2020) Timing of early laparoscopic cholecystectomy for acute calculous cholecystitis revised: protocol of a systematic review and meta-analysis of results. World J Emerg Surg 15:1. https://doi.org/10.1186/s13017-019-0285-7CrossRefPubMedPubMedCentral

Murphy MM, Ng SC, Simons JP et al (2010) Predictors of major complications after laparoscopic cholecystectomy: surgeon, hospital, or patient? J Am Coll Surg 211:73–80. https://doi.org/10.1016/j.jamcollsurg.2010.02.050CrossRefPubMed

Kamalapurkar D, Pang TCY, Siriwardhane M et al (2015) Index cholecystectomy in grade II and III acute calculous cholecystitis is feasible and safe. ANZ J Surg 85:854–859. https://doi.org/10.1111/ans.12986CrossRefPubMed

Vaccari S, Cervellera M, Lauro A et al (2020) Laparoscopic cholecystectomy: which predicting factors of conversion? Two Italian center’s study. Minerva Chir. https://doi.org/10.23736/S0026-4733.20.08228-0CrossRefPubMed

10.

Duca S, Bãlã O, Al-Hajjar N et al (2003) Laparoscopic cholecystectomy: incidents and complications. A retrospective analysis of 9542 consecutive laparoscopic operations. HPB 5:152–158. https://doi.org/10.1080/13651820310015293CrossRefPubMedPubMedCentral

11.

Terho PM, Leppäniemi AK, Mentula PJ (2016) Laparoscopic cholecystectomy for acute calculous cholecystitis: a retrospective study assessing risk factors for conversion and complications. World J Emerg Surg 11:54. https://doi.org/10.1186/s13017-016-0111-4CrossRefPubMedPubMedCentral

12.

Isazadehfar K, Entezariasl M, Shahbazzadegan B et al (2017) The comparative study of ondansetron and metoclopramide effects in reducing nausea and vomiting after laparoscopic cholecystectomy. Acta Med Iran 55:254–258PubMed

13.

Salman N, Aykut A, Sabuncu Ü et al (2020) Dextrose administration may reduce the incidence of postoperative nausea and vomiting after laporoscopic cholecystectomy: a double blind randomized controlled trial. Minerva Anestesiol. https://doi.org/10.23736/S0375-9393.20.13484-9CrossRefPubMed

14.

Zhou C, Zhu Y, Liu Z, Ruan L (2016) 5HT3 antagonists versus dexamethasone in the prevention of PONV in patients undergoing laparoscopic cholecystectomy: a meta-analysis of RCTs. Biomed Res Int 2016:8603409. https://doi.org/10.1155/2016/8603409CrossRefPubMedPubMedCentral

15.

Ko-Iam W, Sandhu T, Paiboonworachat S et al (2017) Predictive factors for a long hospital stay in patients undergoing laparoscopic cholecystectomy. Int J Hepatol. https://doi.org/10.1155/2017/5497936CrossRefPubMedPubMedCentral

16.

Barazanchi AWH, MacFater WS, Rahiri JL et al (2018) Evidence-based management of pain after laparoscopic cholecystectomy: a PROSPECT review update. Br J Anaesth 121:787–803CrossRefPubMed

17.

Loizides S, Gurusamy KS, Nagendran M et al (2014) Wound infiltration with local anaesthetic agents for laparoscopic cholecystectomy. Cochrane Database Syst. Rev. 2014:CD007049

18.

Brown JK, Singh K, Dumitru R et al (2018) The benefits of enhanced recovery after surgery programs and their application in cardiothoracic surgery. Methodist Debakey Cardiovasc J 14:77–88PubMedPubMedCentral

19.

Brustia P, Renghi A, Gramaglia L et al (2003) Mininvasive abdominal aortic surgery. Early recovery and reduced hospitalization after multidisciplinary approach. J Cardiovasc Surg 44:629–635

20.

Garcés-Albir M, Martín-Gorgojo V, Perdomo R et al (2019) Acute cholecystitis in elderly and high-risk surgical patients: is percutaneous cholecystostomy preferable to emergency cholecystectomy? J Gastrointest Surg. https://doi.org/10.1007/s11605-019-04424-5CrossRefPubMed

21.

Trevino CM, Katchko KM, Verhaalen AL et al (2016) Cost effectiveness of a fast-track protocol for urgent laparoscopic cholecystectomies and appendectomies. World J Surg 40:856–862. https://doi.org/10.1007/s00268-015-3266-3CrossRefPubMed

22.

Scott MJ, Baldini G, Fearon KCH et al (2015) Enhanced recovery after surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations. Acta Anaesthesiol Scand 59:1212–1231CrossRefPubMedPubMedCentral

23.

Paduraru M, Ponchietti L, Casas IM et al (2017) Enhanced recovery after emergency surgery: a systematic review. Bull Emerg Trauma 5:70–78PubMedPubMedCentral

24.

Hamill JK, Rahiri JL, Gunaratna G, Hill AG (2017) Interventions to optimize recovery after laparoscopic appendectomy: a scoping review. Surg Endosc 31:2357–2365. https://doi.org/10.1007/s00464-016-5274-2CrossRefPubMed

25.

Takada T, Strasberg SM, Solomkin JS et al (2013) TG13: updated Tokyo guidelines for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 20:1–7. https://doi.org/10.1007/s00534-012-0566-yCrossRefPubMed

26.

Nechay T, Sazhin A, Titkova S et al (2020) Evaluation of enhanced recovery after surgery program components implemented in laparoscopic appendectomy: prospective randomized clinical study. Sci Rep. https://doi.org/10.1038/s41598-020-67591-5CrossRefPubMedPubMedCentral

27.

Hefermehl LJ, Largo RA, Hermanns T et al (2014) Lateral temperature spread of monopolar, bipolar and ultrasonic instruments for robot-assisted laparoscopic surgery. BJU Int 114:245–252. https://doi.org/10.1111/bju.12498CrossRefPubMed

28.

Clavien PA, Barkun J, De Oliveira ML et al (2009) The clavien-dindo classification of surgical complications: Five-year experience. Ann Surg 250:187–196CrossRefPubMed

29.

Зaтeвaxин ИИ, Caжин AB, Киpиeнкo AИ et al (2020) Диaгнocтичecкиe и лeчeбныe пoдxoды пpи ocтpoм aппeндицитe в пpaктикe xиpypгoв Poccийcкoй Фeдepaции. Peзyльтaты oбщepoccийcкoгo oпpoca. Xиpypгия им HИПиpoгoвa No 8:5–16

30.

Hamill JK, Rahiri J-L, Gunaratna G, Hill AG (2017) Interventions to optimize recovery after laparoscopic appendectomy: a scoping review and other interventional techniques. Surg Endosc. https://doi.org/10.1007/s00464-016-5274-2CrossRefPubMed

31.

Wisely JC, Barclay KL (2016) Effects of an enhanced recovery after surgery programme on emergency surgical patients. ANZ J Surg 86:883–888. https://doi.org/10.1111/ans.13465CrossRefPubMed

32.

Gurusamy KS et al (2014) Methods of intraperitoneal local anaesthetic instillation for laparoscopic cholecystectomy (review). Summary of findings for the main comparison. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD009060.pub2CrossRefPubMedPubMedCentral

33.

Boddy A, Mehta S, Rhodes M (2006) The effect of intraperitoneal local anesthesia in laparoscopic cholecystectomy: a systematic review and meta-analysis. Anesth Analg 103:682–688. https://doi.org/10.1213/01.ane.0000226268.06279.5aCrossRefPubMed

34.

Gurusamy KS, Vaughan J, Davidson BR (2014) Low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy. Cochrane Database Syst Rev. 2014(3):CD006930. https://doi.org/10.1002/14651858.CD006930.pub3

35.

Bajracharya JL, Subedi A, Pokharel K, Bhattarai B (2019) The effect of intraoperative lidocaine versus esmolol infusion on postoperative analgesia in laparoscopic cholecystectomy: a randomized clinical trial. BMC Anesthesiol 19:198. https://doi.org/10.1186/s12871-019-0874-8CrossRefPubMedPubMedCentral

36.

Khandelwal H, Parag K, Singh A et al (2019) Comparison of subcostal transversus abdominis block with intraperitoneal instillation of levobupivacaine for pain relief after laparoscopic cholecystectomy: a prospective study. Anesth Essays Res 13:144–148. https://doi.org/10.4103/aer.AER_3_19CrossRefPubMedPubMedCentral

37.

Matsuzaki S, Vernis L, Bonnin M et al (2017) Effects of low intraperitoneal pressure and a warmed, humidified carbon dioxide gas in laparoscopic surgery: a randomized clinical trial. Sci Rep. https://doi.org/10.1038/s41598-017-10769-1CrossRefPubMedPubMedCentral

38.

Ljungqvist O, Scott M, Fearon KC (2017) Enhanced recovery after surgery a review. JAMA Surg 152:292–298CrossRefPubMed

39.

Xu D, Zhu X, Xu Y, Zhang L (2017) Shortened preoperative fasting for prevention of complications associated with laparoscopic cholecystectomy: a meta-analysis. J Int Med Res 45:22–37. https://doi.org/10.1177/0300060516676411CrossRefPubMedPubMedCentral

40.

Çetinkaya F (2019) The effects of listening to music on the postoperative nausea and vomiting. Complement Ther Clin Pract 35:278–283. https://doi.org/10.1016/j.ctcp.2019.03.003CrossRefPubMed

41.

Hossain MM, Begum M, Hossain M et al (2019) Efficacy of palonosetron as antiemetic prophylaxis for post operative patients. Mymensingh Med J 28:222–229PubMed

42.

Gustafsson UO, Scott MJ, Schwenk W et al (2012) Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS^®) Society recommendations. Clin Nutr 31:783–800. https://doi.org/10.1016/j.clnu.2012.08.013CrossRefPubMed

43.

Shah JN, Maharjan SB, Manandhar K (2012) Early feeding and discontinuation of intravenous fluid after laparoscopic cholecystectomy. J Nepal Health Res Council 10:28–31

44.

Cestonaro T, Madalozzo Schieferdecker ME, Daniela Thieme R et al (2014) The reality of the surgical fasting time in the era of the ERAS protocol. Nutr Hosp 29:437–443. https://doi.org/10.3305/nh.2014.29.2.7025CrossRefPubMed

45.

De Aguilar-Nascimento JE, Leal FS, Dantas DCS et al (2014) Preoperative education in cholecystectomy in the context of a multimodal protocol of perioperative care: a randomized, controlled trial. World J Surg 38:357–362. https://doi.org/10.1007/s00268-013-2255-7CrossRefPubMed

46.

Kleif J, Vilandt J, Gögenur I (2016) Recovery and convalescence after laparoscopic surgery for appendicitis: a longitudinal cohort study. J Surg Res 205:407–418. https://doi.org/10.1016/j.jss.2016.06.083CrossRefPubMed

47.

Yeh A, Butler G, Strotmeyer S et al (2020) ERAS protocol for pediatric laparoscopic cholecystectomy promotes safe and early discharge. J Pediatr Surg 55:96–100. https://doi.org/10.1016/j.jpedsurg.2019.09.053CrossRefPubMed

48.

Pucher PH, Brunt LM, Davies N et al (2018) Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis. Surg Endosc 32:2175–2183. https://doi.org/10.1007/s00464-017-5974-2CrossRefPubMedPubMedCentral

49.

Roulin D, Blanc C, Muradbegovic M et al (2014) Enhanced recovery pathway for urgent colectomy. World J Surg 38:2153–2159. https://doi.org/10.1007/s00268-014-2518-yCrossRefPubMed

Title: Modified enhanced recovery after surgery protocol in patients with acute cholecystitis: efficacy, safety and feasibility. Multicenter randomized control study
Authors: Taras Nechay
Svetlana Titkova
Alexander Tyagunov
Mikhail Anurov
Alexander Sazhin
Publication date: 01-08-2021
Publisher: Springer International Publishing
Keywords: Cholecystitis
Laparoscopy
Cholecystectomy
Postoperative Nausea and Vomiting
Published in: Updates in Surgery / Issue 4/2021
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI: https://doi.org/10.1007/s13304-021-01031-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Modified enhanced recovery after surgery protocol in patients with acute cholecystitis: efficacy, safety and feasibility. Multicenter randomized control study

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2021

Risk factors of conversion in robotic- and video-assisted pulmonary surgery for non-small cell lung cancer

Combined cervicosternotomy and cervicotomy for true retrosternal goiters: a surgical cohort study

Letter to the editor

Bariatric surgery in over 60 years old patients: is it worth it?

The THYCOVIT (Thyroid Surgery during COVID-19 pandemic in Italy) study: results from a nationwide, multicentric, case-controlled study

A novel and simple technique to close the enterotomy after intracorporeal anastomosis in laparoscopic right hemicolectomy