Application Of Enhanced Recovery After Surgery By Early Feeding After Laparoscopic Papillary Catheter Dilation

Objective: The management of early postoperative feeding in patients undergoing laparoscopic papillary catheter dilation surgery was studied.The aim of this randomized controlled trial was to explore the safety,reliability and advantages of the enhanced recovery after surgery(ERAS)by early oral feeding after Laparoscopic papillary catheter dilation surgery.Methods: The prospective randomized controlled study was used to calculate the sample size according to the calculation formula of the two-sample-average-comparison sample content.From May 15,2017 to December 3,2018,patients with extrahepatic bile duct stones were collected after inclusion and exclusion criteria,which come from the department of hepatobiliary and pancreatic surgery in the second people Hospital of chengdu.All of them signed informed consent and underwent the elective Laparoscopic common bile duct exploration(LCBDE)and Laparoscopic papillary catheter dilation(LPCD)and if gallbladder stone was involved,the Laparoscopic cholecystectomy(LC)was underwent.All were treated with controlled ERAS program.They were randomly divided into the experimental group and the control group after surgery.The experimental group: without obvious nausea and vomiting,the patients were instructed to drink a small amount of water until 6 hours after surgery.If no discomfort,the patients were intermittently fed rice soup(400ml).The patients were instructed to eat vegetables,fruits,brown rice and other semi-liquid food(1000ml/d)until one day after surgery.Then gradually revert to a low-fat diet.The control group: without obvious nausea and vomiting,the patients were instructed to drink a small amount of water until 12 hours after surgery.If no discomfort,the patients were intermittently fed rice soup(400ml).The patients were instructed to eat vegetables,fruits,brown rice and other semi-liquid food(1000ml/d)until one day after surgery.Then gradually revert to a low-fat diet.The clinical data of two groups were collected and compared.The main subjects were gender,age,preoperative nutritional index(body mass index,nutritional risk screening 2002,albumin),preoperative liver function(alanine aminotransferase,aspartate aminotransferase,total bilirubin,direct bilirubin),time of operation,blood loss,diameter of common bile duct,size and quantity of common bile duct stones,time of bowel sound recovery,time to first flatus and stool,postoperative nutritional indicators,postoperative liver function,postoperative complications,hospital stay after surgery,hospital cost.Results: A total of 84 patients were recruited in the clinical study after inclusion and exclusion criteria,including 42 in the experimental group and 42 in the control group.One patient in the experimental group and one in the control group failed to take food on time.Postoperative pancreatitis occurred 1 case in the experimental group and 2 cases in the control group.In the final 79 patients completed the study,including 40 in the experimental group and 39 in the control group.Preoperative baseline data of patients in the two groups showed no statistical difference in gender,age,preoperative liver function,preoperative nutrition indexes,etc.(P > 0.05).Intraoperative conditions of the two groups: the differences were not statistically significant in operative time,blood loss,diameter of common bile duct,size and quantity of common bile duct stones(P > 0.05).No significantly differences were seen in the postoperative alanine aminotransferase,aspartate aminotransferase,total bilirubin,direct bilirubin and complications between the two groups(P > 0.05).The experimental group was superior to the control group in the time of bowel sound recovery,time to first flatus and stool,postoperative albumin,hospital stay after surgery and hospital cost.The difference was statistically significant(P < 0.05).Conclusion:(1)It is safe and reliable to implement ERAS program in early postoperative feeding in patients undergoing laparoscopic papillary catheter dilation surgery.(2)After anesthesia recovery period,earlier oral feeding can accelerate the recovery of gastrointestinal function and nutrition,decrease the amount of postoperative infusion,enhance postoperative recovery,shorten the postoperative hospital stay,reduce hospital cost,and can not increase the incidence of postoperative complications than later oral feeding.