The Application Of Fast Track Surgery To The Perioperative Period Of Esophageal Hiatal Hernia

Objective We studied the application of FTS to theperioperative period of esophageal hiatal hernia and observed theeffect of FTS on patients’ postoperative inflammation,complications and length of postoperative hospital stay, aiming toexplore the safety and value of FTS in esophageal hiatal hernia.Methods In the study we collected36cases, from March2013to December2014, who were hospitalized in the thoracicdepartment of the first Bethune hospital, Jilin University, andwere divided into the FTS group(17cases) and the controlgroup(19cases). The concepts of FTS were applied to theperioperative management of the FTS group,whereas thecontrol group adopted the routine one.All cases were clearlydiagnosed by lung CT scan, Upper Gastrointestinal Contrast,endoscopy and partly by the esophageal manometry and24hour PH determination. We adopt the non-randomized controlto compare the length of operation, intraoperative fluidadministered, blood loss and urine output, time to removenasogastric tube, time to withdraw abdominal drainage tube,time to take the first diet,post-operative complications, theincidence of postoperative ventosity and nausea, the level ofwhite cell and neutrophil granulocyte on the first postoperative day, the length of hospital stay and so on.Results The length of operation and blood loss showedno significant difference, however, the intraoperative fluidadministered was significantly less in FTS group(P<0.01) andthe urine output was also less in FTS group(P<0.05). The FTSgroup revealed significantly earlier in the time to remove naso-gastric tube, time to withdraw abdominal drainage tube andtime to take the first diet and a shorter length of hospital stay（P<0.01）. The level of white cell was lower compared withthe control group,but the neutrophil granulocyte showed nodifference on the first postoperative day in FTS group.Although the total postoperative complications were lower inFTS group, the incidence of postoperative ventosity andnausea had no difference each other.We made a post-operative telephone follow-up(2months to2years), there wasa recurrence two months after discharge in control group andzero in FTS group, which had no difference between twogroups. One cases in the FTS group had a feeling of chokingwhen taking solid diets,but the symptom disappeared bit by bitafter3months. As for the recurrence one in control group, whowas improved and discharged after conservative treatment.Conclusion The application of FTS to the perioperative period of esophageal hiatal hernia is safe and effective. The FTScan shorten the time to remove nasogastric tube, time to with-draw abdominal drainage tube and time to take the first dietand length of hospital stay, and accelerates postoperativerecovery. FTS process can help to reduce the total post-operative complications, but doesn’t increase associated post-operative complications. The FTS might reduce postoperativeinflammation and stress response.