Published online Mar 27, 2024. doi: 10.4240/wjgs.v16.i3.816
Peer-review started: January 12, 2024
First decision: January 31, 2024
Revised: February 9, 2024
Accepted: February 25, 2024
Article in press: February 25, 2024
Published online: March 27, 2024
Processing time: 70 Days and 7.3 Hours
Enhanced recovery after surgery (ERAS) protocol is a comprehensive manage
To study the application value of ERAS in laparoscopic surgery for acute appen
A total of 120 patients who underwent laparoscopic appendectomy due to acute appendicitis were divided into experimental group and control group by random number table method, including 63 patients in the experimental group and 57 patients in the control group. Patients in the experimental group were managed with the ERAS protocol, and those in the control group were received the tra
There was no significant difference in age, gender, body mass index and Sunshine Appendicitis Grading System score between the experimental group and the con
ERAS could significantly accelerate the recovery of patients who underwent la
Core Tip: This study focused on the application of enhanced recovery after surgery (ERAS) in patients undergoing laparoscopic appendectomy due to acute appendicitis. Patients often suffer from considerable postoperative pain and indigestion after laparoscopic appendectomy, and approximately 10% of patients experienced postoperative complications, resulting in prolonged hospital stay and increased hospitalization costs. The value of ERAS in elective surgery has been confirmed, but there is limited research on emergency surgery. This study found that ERAS could accelerate the recovery of patients who underwent laparoscopic appendectomy due to acute appendicitis.
- Citation: Li ZL, Ma HC, Yang Y, Chen JJ, Wang ZJ. Clinical study of enhanced recovery after surgery in laparoscopic appendectomy for acute appendicitis. World J Gastrointest Surg 2024; 16(3): 816-822
- URL: https://www.wjgnet.com/1948-9366/full/v16/i3/816.htm
- DOI: https://dx.doi.org/10.4240/wjgs.v16.i3.816
Enhanced recovery after surgery (ERAS) was a therapeutic concept. It optimizes clinical pathways through multidisciplinary collaboration such as surgery, anesthesia, and nursing, reducing the physiological and psychological stress re
Appendicitis was the most common acute abdomen in the world, with an incidence rate of approximately one in a thousand in adults[5]. Surgery remained the main treatment for acute appendicitis. Patients often experienced varying degrees of pain and indigestion after surgery, which could prolong hospital stay and increase the risk of postoperative complications. The role of ERAS in the field of elective surgery is evident, but there is currently limited research on its role in emergency surgery. This study aims to explore the feasibility and clinical effects of ERAS in laparoscopic appen
Inclusion criteria were as follows: (1) Aged 18-70 years; (2) American society of Anesthesiologists score I-II; (3) Non-gestational appendicitis; and (4) No history of abdominal surgery.
This study is a prospective randomized controlled study. A total of 120 patients who met the inclusion criteria and were diagnosed with acute appendicitis before surgery between March 2018 and March 2020 were randomly divided into an experimental group and a control group using a random number table method. The experimental group consisted of 63 patients (34 males and 29 females) and the control group consisted of 57 patients (26 males and 31 females). The severity of acute appendicitis was evaluated on the Sunshine Appendicitis Grading System (SAGS) score published in 2017[6]. SAGS 1- SAGS 4 represented simple appendicitis, purulent appendicitis, purulent appendicitis with four qua
The experimental group adopted the ERAS protocol for perioperative management, while the control group adopted traditional methods for perioperative management. The specific methods used were shown in Table 1. All patients un
Control group | Experimental group | |
Food and drink | Eat liquid diet and drink water after exhaust | Eat liquid diet 12 h after surgery |
Off-bed activity | Voluntary | Off-bed activity 6 h after surgery |
Pain relief for wounds | No | Wound infiltration anesthesia with ropivacaine |
Postoperative analgesia | Use painkilling drug when the pain is obvious | Intravenous NSAIDs were administered for analgesia on the first day after surgery |
Oral administration of Si Mo Tang | No | Oral administration of the drug 10 mL/dose on postoperative day 1-2, tid |
Chewing gum | No | Starting at 6 h after surgery, 20 min per session, tid |
Observation indicators included postoperative recovery time of gastrointestinal function, hospitalization stay, hospitalization expenses, and pain score (Table 2). The pain score was evaluated using the numerical rating scale, which was evaluated six hours after surgery by chief surgeon.
Experimental group | Control group | P value | |
Postoperative exhaust time (h) | 17.18 ± 5.87 | 23.09 ± 6.18 | < 0.01 |
Postoperative hospitalization time (d) | 3.44 ± 1.23 | 4.63 ± 1.84 | < 0.01 |
Hospitalization expenses (CNY) | 8538.54 ± 1435.27 | 9493.41 ± 1814.11 | < 0.01 |
Degree of pain sensation (NRS) | 2.92 ± 0.69 | 4.80 ± 1.35 | < 0.01 |
SPSS22.0 statistical software was used to analyze the data. Quantitative data of normal distribution were expressed as mean ± SD. The t-test of two independent samples was used for inter-group comparison, and the Chi-square test was used to analyze the differences in the clinicopathological features between the experimental and control groups. The difference was statistically significant with P < 0.05.
In the experimental group, the patients included 34 males and 29 females and ranged from 16-years-old to 69-years-old (38.5 ± 13.7 years). There were 11 patients whose body mass index (BMI) exceed 25 kg/m2 and 52 patients whose BMI did not exceed 25 kg/m2. There were 30 cases in SAGS score 2 group and 15 cases in SAGS score 3 group. In the control group, the patients included 26 males and 31 females and ranged from 15-years-old to 70-years-old (39.7 ± 14.6 years). There were 14 patients whose BMI exceed 25 kg/m2 and 43 patients whose BMI did not exceed 25 kg/m2. There were no statistically significant differences in age, gender, BMI and SAGS score between the experimental group and the control group (P > 0.05; Table 3).
Clinicopathological features | n | Experimental group | Control group | P value |
Sex | 120 | 63 | 57 | |
Male | 60 | 34 | 26 | 0.361 |
Female | 60 | 29 | 31 | |
Age (yr) | ||||
≤ 60 | 107 | 58 | 49 | 0.283 |
> 60 | 13 | 5 | 8 | |
BMI | ||||
≤ 25 kg/m2 | 95 | 52 | 43 | 0.339 |
> 25 kg/m2 | 25 | 11 | 14 | |
SAGS score | ||||
1 | 27 | 11 | 16 | 0.381 |
2 | 51 | 30 | 21 | |
3 | 31 | 15 | 16 | |
4 | 11 | 7 | 4 |
Both groups of surgeries were successful and there was no conversion to open surgery. Compared with the control group, patients in experimental group had earlier postoperative exhaust time, shorter hospital stay, lower hospitalization costs, and lower pain scores. The differences between the two groups were statistically significant (P < 0.05; Table 2).
One patient in the control group had wound infection and one patient in the experimental group had urinary retention. The other patients did not have complications such as lung infection, abdominal abscess, urinary tract infection, etc. All patients recovered well and were discharged.
With the transformation of medical models, solving psychological and social factors reflected a comprehensive care for improvement of health at a higher level. Therefore, reducing patients' pain and accelerating their recovery had become practical and urgent. The concept of ERAS was proposed by optimizing the perioperative management process, reducing stress reactions and postoperative complications, thereby shortening hospitalization duration and accelerating patient recovery. This concept was introduced into China in 2006 and gradually applied in surgical treatment in multiple disciplines such as gastrointestinal surgery, thoracic surgery, and urology, achieving positive clinical outcome[7-9].
In this study, administration of sufficient postoperative analgesia and the promotion of gastrointestinal function recovery were the focus of our attention. Research had shown that active and effective pain relief could alleviate patients' fear of pain, facilitate early off-bed activity, and accelerate the recovery of patient organ function[10]. The current mode of postoperative analgesia had shifted from single mode analgesia to multi-mode analgesia[11]. Compared to single mode analgesia dominated by opioids, multimodal analgesia was a type of analgesic mode that combined analgesic drugs or methods with different mechanisms of action. The aim of this model was to increase the analgesic effect and reduce adverse reactions through the complementarity of different drug mechanisms[12]. Regarding the pain after abdominal surgery, which mainly includes visceral pain, incision pain, and inflammatory pain, we used ropivacaine to locally infil
Postoperative gastrointestinal dysfunction may occur to varying degrees, with clinical manifestations including post
A limitation of this study was the use of a small number of patients in a single center, in the future, a multicenter study with a larger sample size is needed to further confirm our findings.
In summary, this study applied the concept of ERAS during the perioperative period of laparoscopic surgery for acute appendicitis. Compared with the control group, the experimental group showed a significant improvement in recovery, characterized by earlier exhaust time, shorter hospitalization time, lower hospitalization costs, and lower patient pain scores. Therefore, applying the concept of ERAS to laparoscopic appendectomy was safe, economical and effective, and was worth further promotion and implementation.
Enhanced recovery after surgery (ERAS) protocol has shown to be beneficial to patients undergoing various abdominal surgeries, especially in the digestive tumor surgery. However, few studies have explored the application of ERAS in laparoscopic surgery for acute appendicitis.
To determine if ERAS is beneficial to patients undergoing laparoscopic surgery for acute appendicitis.
This study aimed to evaluate the value of ERAS in laparoscopic surgery for acute appendicitis.
A prospective randomized controlled study was performed in Beijing Chao-Yang Hospital. A total of 120 patients who met the inclusion criteria and were diagnosed with acute appendicitis before surgery between March 2018 and March 2020 were randomly divided into an experimental group and a control group using a random number table method. The clinicopathological features of the two groups were analyzed. In addition, variables including gastrointestinal function recovery time, hospitalization duration, hospitalization costs, and pain scores were also analyzed.
One hundred and twenty patients were included. There were 63 patients in the experimental group and 57 patients in the control group. There was no significant difference in age, gender, body mass index and Sunshine Appendicitis Grading System score between the two groups (P > 0.05). The application of ERAS resulted in accelerated recovery of acute appendicitis patients, shorter hospitalization stay, less hospitalization costs, earlier postoperative exhaust time, and milder pain.
The application of ERAS is associated with shorter hospitalization stay, less hospitalization costs, earlier postoperative exhaust time, and milder pain in the patients who underwent laparoscopic appendectomy due to acute appendicitis. It is safe, economical and effective.
The findings in this study can encourage surgeons to pay more attention to postoperative management measures for patients with acute appendicitis, and to apply the concept of ERAS to their postoperative recovery, thereby reducing the burden on patients and saving medical resources.
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Gastroenterology and hepatology
Country/Territory of origin: China
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P-Reviewer: Ohkura Y, Japan S-Editor: Li L L-Editor: A P-Editor: Xu ZH
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