Enhanced Recovery After Splenectomy And Esophagogastric Devascularization

Object This aim of this study was conducted to investigate the effect and meaning of enhanced recovery after surgery(ERAS) after splenectomy and esophagogastric devascularization.Methods A retrospective review of 283 patients who had got liver cirrhosis with portal hypertension undergoing splenectomy and esophagogastric devascularization was carried out from September 2013 to April 2016, the 140 patients of conventional group were from September 2013 to October 2014 not following the treatment of enhanced recovery after surgery, The 143 patients of enhanced recovery group were from November 2014 to April 2016 following the treatment of enhanced recovery after surgery. Postoperative recovery of liver function, the occurrence of postoperative complications and postoperative hospital stay were collected and contrasted between two group. P<0.05 was considered statistically significant.Result By comparing the group following enhanced recovery programmes with traditional treatment group, postoperative hospital stay has no statistically significant difference(P > 0.05), in the group following enhanced recovery programmes, the incidence of moderate-severe ascites, throat discomfort, and nausea, vomiting, abdominal distension were reduced, statistically significantly(P < 0.05). By comparing enhanced recovery group with conventional treatment group, the difference of postoperative hospital stay and postoperative complications in patients classed in Child-Pugh A grade had no statistical significance(P > 0.05); Postoperative hospital stay in patients classed in Child –Pugh B grade following enhanced recovery programmes was 13.6 ± 5.4 days shorter than 16.0±2.7days not following enhanced recovery programmes with statistical significance(P < 0.05), and gastrointestinal discomfort(nausea, vomiting, abdominal distension) is reduced by stimulating Tsusanli(P < 0.05). moderate-severe ascites, nausea, vomiting, abdominal distension, and throat discomfort were reduced with statistical significance(P < 0.05). In the ERAS group,Conclusion The liver function of the patient with hepatitis cirrhosis determines the postoperative hospital stay. Enhanced recovery programmes could reduce postoperative ascites, throat discomfort, gastrointestinal discomfort(nausea, vomiting, abdominal distension) significantly, but the effect of enhanced recovery after surgery(ERAS) after splenectomy and esophagogastric devascularization that reduced postoperative complications improve the patient's recovery speed, and shorten the hospitalization time is not obvious. Especially when the liver function is Child- Pugh grade A, Enhanced recovery programmes has no clinical significance in the postoperative hospital stay and incidence of complications. When liver function is Child- Pugh grade B, the practice of enhanced recovery programmes(ERAS) is safe and effective, promoting the recovery of Child-Pugh grade B patients after splenectomy and esophagogastric devascularization severed is significance, stimulating Tsusanli can accelerate the recovery of gastrointestinal function and reduce gastrointestinal discomfort.