Application value of enhanced recovery after surgery for total laparoscopic uncut Roux-en-Y gastrojejunostomy after distal gastrectomy

Table 1 Clinical information of the patients

Clinical information	ERAS group (n = 20)	Control group (n = 22)	Statistics	P value
Age (yr, mean ± SD)	71.5 ± 8.1	72.9 ± 6.7	t = 0.613	> 0.05
Sex (male/female)	14/6	17/5	χ2 = 0.287	> 0.05
Body mass index, (kg/m2, mean ± SD)	23.6 ± 3.4	22.8 ± 4.6	t = 0.636	> 0.05

ERAS: Enhanced recovery after surgery.

Table 2 Perioperative treatment program

Perioperative treatment program	ERAS Group	Control group
Preoperative
Preparation	ERAS-related health education to alleviate tension in patients performed by both surgeons and anesthesiologists. The definition of the visual analog scale was explained to patients.	Regular preoperative education and preoperative conversation only with surgeons, and the definition of the visual analogue scale was explained to patients.
Diet	Patients drank 1000 mL of a 10% glucose solution 10 h before surgery and 500 mL of the 10% glucose solution 2 h before surgery.	Fasting for 12 h before surgery No drinking for 6 h before surgery
Bowel preparation	None	The bowel was cleaned twice the day before surgery and the day of surgery.
Intraoperative
Nasogastric tube	Not used	Removed after exhaust
Body temperature	Intraoperative warm-air body heating	None
Urinary catheter	Removed after waking from anesthesia	1 d after surgery
Postoperative
Anesthesia and analgesics	Local anesthesia at surgical incision + PCIA + NSAIDs	PCIA
Diet	Patients chewed gum after waking from anesthesia, drank water 6 h after surgery, and were encouraged to remain on a liquid diet until return to a normal diet.	Patients drank water after anal exhaust and gradually returned to a normal diet.
Activity	Patients were encouraged to get out of bed for more than 6 h a day and walk the length of the ward.	Decided by patients

ERAS: Enhanced recovery after surgery.

Table 3 Operation conditions

Operation parameter	ERAS group (n = 20)	Control group (n = 22)	Statistics	P value
Operative time (min, mean ± SD)	217.9 ± 52.5	225.4 ± 61.7	t = 0.422	> 0.05
Volume of intraoperative blood loss (mL, mean ± SD)	166.1 ± 12.5	150.9 ± 31.7	χ2 = 2.006	> 0.05
Open surgery	2	1	t = 0.01	> 0.05

ERAS: Enhanced recovery after surgery.

Table 4 Postoperative clinical indexes

Index	ERAS group (n = 20)	Control group (n = 22)	Statistics	P value
Time to initial anal exhaust (d, mean ± SD)	2.9 ± 1.1	3.7 ± 1.4	t = 2.045	< 0.05
Time to initial liquid diet intake (d, mean ± SD)	1.6 ± 0.7	4.1 ± 1.1	t = 8.685	< 0.05
Time to out-of-bed activity (d, mean ± SD)	2.3 ± 0.8	4.2 ± 3.2	= 2.580	< 0.05
Time to initial defecation (d, mean ± SD)	4.2 ± 1.7	4.9 ± 2.0	t = 1.216	> 0.05
Time to abdominal drainage tube removal (d, mean ± SD)	7.3 ± 2.6	8.7 ± 3.2	t = 1.546	> 0.05
Duration of hospital stay of patients without complications (d, mean ± SD)	7.5 ± 1.6	10.2 ± 2.1	t = 4.650	< 0.05
Early postoperative complications	1	1	χ2 = 0.430	> 0.05
VAS POD1 (points, mean ± SD)	4.0 ± 1.4	5.4 ± 1.6	= 2.361	< 0.05
VAS POD3 (points, mean ± SD)	3.5 ± 1.8	4.8 ± 1.5	= 2.551	< 0.05

ERAS: Enhanced recovery after surgery; POD: Postoperative day.

Table 5 Postoperative serum stress indexes

Stress index (mean ± SD)	ERAS group (n = 20)	Control group (n = 22)	Statistics	P value
WBC POD1 (× 109/L)	12.7 ± 3.1	15.2 ± 4.2	t = 2.176	< 0.05
WBC POD3 (× 109/L)	9.5 ± 2.6	12.4 ± 3.3	t = 3.141	< 0.05
CRP POD1 (mg/dL)	7.5 ± 2.9	11.2 ± 3.4	= 3.775	< 0.05
CRP POD3 (mg/dL)	5.3 ± 3.1	7.3 ± 2.8	= 2.197	< 0.05
IL-6 PDO1 (pg/dL)	55.2 ± 21.9	85.7 ± 35.6	t = 3.303	< 0.05
IL-6 POD3 (pg/dL)	20.3 ± 5.7	24.1 ± 6.2	t = 2.061	< 0.05

ERAS: Enhanced recovery after surgery; POD: Postoperative day; WBC: White blood cell count; CRP: C reactive protein; IL-6: Interleukin-6.