Safety And Efficiency Of Fast Track Surgery Strategy For Patients Undergoing Retroperitoneal Laparoscopic Adrenalectomy

Objective:The objective of this randomized controlled study was to evaluate the impact of fast track (FTS) surgery on recovery after retroperitoneal laparoscopic adrenalectomy.Methods:Eighty patients were randomly assigned to fast tract groups and conventional groups (n=40in each group).These patients undergoing retroperitoneal laparoscopic adrenalectomy received either conventional care or an FTS recovery program. The first time of flatus, time of oral nutrition, time of drain and transurethral catheterization usage, time of mobilization, hospital discharge times after surgery, hospitalization expenses, incidence of complications related gastrointestinal tract, general state and postoperative complications were compared between the two groups. Blood samples were analyzed for interleukin-1-beta (IL-1β), interleukin-6(IL-6), interleukin-10(IL-10), tumor necrosis factor-alpha(TNF-α), C reactive protein (CRP), white blood cell count(WBC) at24h before and2,24h after the operation In addition, analgesic efficacy was evaluated for24h postoperatively using visual analogue scale (VAS) pain scores both at rest and during coughing. Patients were discharged home when they met discharge criteria.Results:As compared with the control group, the first time of flatus(20.6±8.3vs39.8±18.3h), time of oral nutrition(21.1±9.9vs51.8±16.9h) were markedly shortened in the study group (P<0.01), so were time of drain(20.9±7.9vs70.6±18.9h) and transurethral catheterization usage (20.2±8.3vs62.5±27.1h)、length of hospital stay(2.43±0.94vs5.46±1.60d) and the hospitalization expenses(0.217±0.032vs0.286±0.065hundred thousand Yuan)(P<0.01); whereas the incidence complications related gastrointestinal tract did not differ significantly (P>0.05). Pain scores were consistently lower in the FTS group during the12h (0.93±0.89vs1.80±1.38) and24h (1.27±0.99vs4.65±1.33) after surgery when they cough and24h (0.70±0.61vs1.40±0.84) when they at rest, CRP、TNF-α、 IL-1β、IL-6、IL-10concentrations at2and24h after the operation were lower compared with control group, white blood cell count differ significantly at24h after surgery (P<0.05), POD1(6.85±1.00vs4.28±1.11) and POD2(8.30±0.94vs5.53±1.24) general state of FTS patients were higher than conventional groups (P <0.01), general state of FTS group between POD2(8.30±0.94vs5.53±1.24) and prioperation (8.30±0.94vs8.13±0.61) did not differ significantly (P>0.05)Conclusions:Fast tract surgery within retroperitoneal laparoscopic adrenalectomy is safe and feasible, it can reduce inflammatory response and enhance general state, shorten length of hospital stay and reduce the hospitalization expenses, a multimodal approach led to accelerate rehabilitation.