The Application Of Eras In Combination With Laparoscopy In Biliary Reoperation For Recurrent Biliary Calculi

Objective To investigate the efficiency and safety of enhanced recovery after surgery(ERAS)in combination with laparoscopy in biliary reoperation for recurrent biliary calculi.Methods A retrospective analysis was made of the data of patients with recurrent biliary calculi who underwent laparoscopic reoperation strictly in accordance with the concept of enhanced recovery after surgery(ERAS)during the perioperative period of surgery(ERAS+laparoscopy group)from Jan 2015 to May 2018 in hospital A,compared with the data of patients with recurrent biliary calculi who underwent laparotomy reoperation in combination with ERAS management(ERAS+open group).The perioperative variables,postoperative morbidity and outcomes were analyzed and compared between the two groups to evaluate the the efficiency and safety of enhanced recovery after surgery(ERAS)in combination with laparoscopy in biliary reoperation.Results A total of 88 cases were collected,including 28 cases in ERAS+laparoscopy group and 60 cases in ERAS+open group.The operation was successfully completed in both groups without severe complications such as intraoperative hemorrhage.ERAS+laparoscopy group had a operation time of 168.93±79.60 min and intraoperative blood loss of 81.50±25.02 ml,while the ERAS+open group had a time of 158.53±76.67 min and intraoperative blood loss of 118.50±83.60 ml.There was no significant difference in the operation time between the two groups(t=0.585,P=0.560),but the intraoperative blood loss of ERAS+laparoscopy group was significantly less than that of the ERAS+open group(t=-3.140,P=0.002).In ERAS+laparoscopic group,theventilation time was 34.64 ±5.76 h,the time of first eating was 1.77 ±0.66 d,the first time to get out of bed was 1.43 ±0.50 d,the drainage tube extraction time was3.93±0.94 d,the urethral extraction time was 1.75 ±0.80 d,the hospitalization time after operation was 6.36 ±2.02 d,the total hospitalization time was 12 ±4.21 d,the hospitalization cost was 1.89 ±0.43 million yuan.In ERAS+open group,the ventilation time was 39.1±8.46 h.The time of first eating was 2.28 ±0.72 d,the first time to get out of bed was 2.12 ±0.78 d,the drainage tube extraction time was 6.00±1.88 days,the urethral extraction time was 3.40 ±0.92 days,the hospitalization time after operation was 10.35 ±5.02 days,the total hospitalization time was 16.60±6.41 days,and the hospitalization cost was 2.38±1.02 million yuan.Postoperative ventilation time(t=-2.526,P=0.013),time of first eating(t=-3.207,P=0.002),time of first getting out of bed(t=-4.250,P=0.000),the drainage tube extraction time(t=-6.893,P=0.000),the urethral extraction time(t=-8.129,P=0.000)in ERAS+laparoscopic group were earlier than those in ERAS+open group,and the hospitalization time after operation(t=-5.309,P=0.000)and the total hospitalization time(t=-4.007,P=0.000)were shorter than those in ERAS+open group.The cost of hospitalization(t=-3.155,P=0.002)was lower than that of the ERAS+open group.In ERAS+laparoscopy group,10 patients had postoperative complications,including 1 case of biliary leakage,3 cases of pulmonary infection,1 case of peritoneal effusion,5 cases of nausea and vomiting and 2 cases of residual calculi.In ERAS+open group,29 patients had postoperative complications,including biliary leakage in 1 case,abdominal hemorrhage in 1 case,incision infection in 5 cases,pulmonary infection in 7 cases,peritoneal effusion in 6 cases,nausea and vomiting in 9 cases and 0 case of residual calculi.There was no statistical difference in the incidence of complications and total complications between the two groups.Conclusion The application of ERAS in combination with laparoscopy in biliary reoperation is safe and effective,it can significantly reduce the stress response ofpatients during perioperative period,shorten the length of hospital stay,reduce the cost of hospitalization and accelerate the recovery of patients,without increase the incidence of complications such as biliary leakage,abdominal hemorrhage,incision infection,pulmonary infection,peritoneal effusion,nausea and vomiting,residual calculi after operation and no stone recurrence or perioperative death occurred in both groups.The application of ERAS in combination with laparoscopy in biliary reoperation accelerate the recovery of patients.