Clarification of issues brought up by 'Is enhanced recovery after surgery protocol has high value in after laparoscopic myomectomy?'.
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ABSTRACT:
SUBMITTER: Chen Y
PROVIDER: S-EPMC9445723 | biostudies-literature | 2022 Aug
REPOSITORIES: biostudies-literature
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Clarification of issues brought up by '<i>Is enhanced recovery after surgery protocol has high value in after laparoscopic myomectomy?</i>'.
Chen Yulian Y Fu Mingru M Huang Guifen G Chen Jiao J
Gland surgery 20220801 8
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| S-EPMC9445726 | biostudies-literature
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| S-EPMC9636453 | biostudies-literature
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| S-EPMC9445719 | biostudies-literature
Project description:AimIt is commonly thought that laparoscopic surgery leads to faster postoperative recovery for its low invasiveness. We evaluated postoperative quality of life (QOL) after laparoscopic myomectomy (LM) by using the Euro-QOL 5 dimension (EQ-5D) score and analyzed its relationship to surgical factors.MethodsBetween 2014 and 2016, 541 patients underwent LM at our institution. We included 86 patients in the final analysis (16% response rate) who replied to the EQ-5D questionnaire, in order to investigate postoperative QOL. We evaluated patients' EQ-5D score before the operation and on the 3rd, 7th, 14th, 21st and 28th postoperative day (POD). We investigated the degree of correlation between the EQ-5D score and four surgical characteristics (operation time, intraoperative bleeding, number of resected myomas and weight of specimen). We examined correlation between EQ-5D scores and chief complaints such as hypermenorrhea, dysmenorrhea, other pain, myoma enlargement, palpable tumor and desire for childbearing. We also examined correlation between EQ-5D scores and other factors such as patient's age, infertility, history of abdominal surgery, marriage and body mass index.ResultsFull recovery, defined as an EQ-5D score of 1.0, was reported 2.3% of patients by POD3, 18.6% by POD7, 58.1% by POD14, 73.3% by POD21 and 86.0% by POD28. Longer duration of operation correlated weakly with poor recovery on POD3. Intraoperative bleeding, number of resected myomas and weight of the specimen did not significantly influence EQ-5D score. There was no correlation between chief complaints or other factors mentioned above and EQ-5D score.ConclusionsMore than a half of the patients undergoing LM included in our study reported full recovery of QOL after 2 weeks. The time to recover QOL was slightly influenced by the operation time. However, when LM was finished without any complications, postoperative QOL eventually seemed to improve regardless of the surgical characteristics such as operation time, intraoperative bleeding, number of resected myomas and weight of specimen.
| S-EPMC6585946 | biostudies-literature
Project description:AimTo study the efficacy of the enhanced recovery after surgery (ERAS) program in laparoscopic radical gastrectomy for stomach carcinomas.MethodsFrom June 2010 to December 2012, 61 gastric cancer patients who underwent laparoscopic-assisted radical gastrectomy with D2 lymphadenectomy at First Hospital of Jilin University were enrolled in this randomized controlled trial. (Clinical Trials.gov, registration ID: NCT01955096). The subjects were divided into the ERAS program group and the conventional control group. The clinical characteristics, recovery variables, and complications of patients were analyzed.ResultsThe time to first ambulation, oral food intake, and time to defecation were significantly shorter in the ERAS group (n = 30), compared to the conventional group (n = 31; P = 0.04, 0.003, and 0.01, respectively). The postoperative hospital stay was less in the ERAS group (6.8 ± 1.1 d) compared to the conventional group (7.7 ± 1.1 d) (P = 0.002). There was no significant difference in postoperative complications between the ERAS (1/30) and conventional care groups (2/31) (P = 1.00). There were no readmissions or mortality during the 30-d follow-up period.ConclusionThe ERAS program is associated with a shorter hospital stay in gastric cancer patients undergoing laparoscopic radical gastrectomy. The ERAS protocol is useful in the treatment of gastric cancer.
| S-EPMC4679767 | biostudies-literature
Project description:Open myomectomy (OM) was previously frequently performed; however, laparoscopic myomectomy (LM) has recently become more common. Nevertheless, myoma can recur after both LM and OM. In this study, we report our retrospective investigation of myoma recurrence by comparing LM and OM.A total of 474 patients underwent LM and 279 patients underwent OM. The patients were followed-up postoperatively from six months to eight years. Recurrence was confirmed when a myoma with a diameter of ≥ 1 cm was detected. Post-LM, post-OM and cumulative recurrence rates were investigated, and a Cox hazard test was performed.The cumulative recurrence rates between the two groups were 76.2% (LM) vs. 63.4% (OM) at eight years postoperatively. A log-rank test revealed a significant difference between the two groups. Cox hazard testing revealed that LM, a larger number of enucleated myoma masses and the absence of postoperative gestation significantly contributed to the postoperative recurrence rate.LM yielded a higher recurrence rate than OM, likely a result of manual myoma removal in OM, which is a more exhaustive extraction of smaller myoma masses than performed in LM. In other words, fewer residual myoma masses after OM contribute to a lower postoperative recurrence rate.
| S-EPMC5836951 | biostudies-other
Project description:BackgroundLaparoscopic distal gastrectomy (LDG) has been highlighted for its safety and better short-term clinical outcomes in treating gastric cancer. However, only a slight reduction of the post-operative hospital stay was observed in gastric cancer patients undergoing LDG with conventional perioperative management, compared to patients undergoing open surgery. Thus, an enhanced recovery after surgery (ERAS) program for LDG is needed to further reduce the post-operative hospital stays. This prospective, open-label, single-arm cohort study aimed to assess the safety and efficacy of the ERAS program for gastric cancer patients undergoing LDG.Material and methodsAll patients with gastric cancer indicated for LDG were consecutively enrolled from December 2016 to January 2018. The ERAS program included short fasting time, effective perioperative pain management, early, goal-oriented ambulation, and oral feeding. The safety assessment was the incidence of post-operative complications, mortality, and readmission in 30 days. The primary efficacy assessment was recovery time defined by post-operative hospital stays and rehabilitative rate on post-operative day 4.ResultsNinety-eight of 114 patients were finally enrolled. The incidence of post-operative complication, mortality, and readmission in 30 days was 20. 4%, 0%, 7.1%, respectively. The Clavien-Dindo grade III complication rate was 6.1%, while the pulmonary complication rate was 1% only. The median post-operative stay was 6 days (5.0-7.0 days), and the rehabilitative rate on post-operative day 4 was 78%.ConclusionsThe ERAS program might be optimal perioperative management for gastric cancer patients after LDG without compromising safety.Trial numberNCT03016026.
| S-EPMC7899858 | biostudies-literature
Project description:BackgroundThe enhanced recovery after surgery (ERAS) program is focused on improving surgical outcomes and enhancing the patient experience before, during and after surgery. We performed this study to evaluate the effect of ERAS in perioperative period of laparoscopic nephron sparing surgery (LNSS).MethodsA retrospective analysis of 287 consecutive patients with localized renal cell carcinoma (RCC) who underwent LNSS from December 2015 to June 2017 was conducted. Our study design included two cohorts. Patients underwent conventional care in one group (n=136), and ERAS protocol in the other group (n=151). The data of recovery of gastrointestinal function, catheter and drainage tube removal time, length of stay (LOS), hospitalization expenses and incidence of postoperative complications were compared between the two groups.ResultsCompared with conventional group, cases in ERAS group presented with shorter time of recovery of gastrointestinal function (P<0.05) and LOS (P<0.05), shorter catheter and drainage tube removal time (P<0.05), lower hospitalization expenses and lower perioperative complications (P<0.05).ConclusionsProgram of ERAS used in perioperative period of LNSS can apparently accelerate the time of postoperative recovery, reduce complications, shorten time stay in hospital and cut down the total cost, finally improve patients' satisfaction.
| S-EPMC7475685 | biostudies-literature
Project description:BackgroundTo explore the impact of enhanced recovery after surgery (ERAS) optimization concept process on the perioperative period of gynecologic laparoscopic surgery.MethodsThis retrospective observational study included patients who underwent gynecologic laparoscopic surgery based on ERAS concept process optimization (ERAS group) for uterine fibroids, adenomyosis, and ovarian cysts at Jiaxing Hospital of Traditional Chinese Medicine between January 2023 and December 2023. Patients who underwent the same laparoscopic protocol without ERAS concept process optimization between January 2022 and December 2022 were matched as the control group (non-ERAS group). Postoperative indexes and patient satisfaction were compared between the two groups.ResultsA total of 120 patients were included, with 60 of who underwent gynecologic laparoscopic surgery (total laparoscopic hysterectomy, TLH: n = 20; laparoscopic myomectomy, LM: n = 20; laparoscopic ovarian cystectomy, LOC: n = 20) based on ERAS (ERAS group), and the other 60 of who underwent gynecologic laparoscopic surgery (TLH: n = 20, LM: n = 20, LOC: n = 20) without ERAS (non-ERAS). In patients received gynecologic laparoscopic surgery of ERAS group, the time of first postoperative gas evacuation, the time of semi-liquid recovery, the time of urination, the time of incision pain, and the length of hospital stay were significantly shorter (all P < 0.001), and the number of nausea and vomiting was significantly reduced (all P < 0.001) compared with those in the non-ERAS group. Besides, satisfaction of patients receiving ERAS was significantly higher than in the non-ERAS group (TLH: P < 0.01; LM and LOC: P < 0.001).ConclusionsERAS optimization for gynecologic laparoscopic surgery improved patients' outcomes, reduced complications, and improved patient's satisfaction.
| S-EPMC11907852 | biostudies-literature
Project description:ObjectiveTo explore patients' experiences of enhanced recovery after surgery (ERAS) and to identify issues in the implementation of ERAS from the patient's perspective.DesignThe systematic review and qualitative analysis were based on the Joanna Briggs Institute's methodology for conducting synthesis.Data sourcesRelevant studies published in four databases, that is, Web of Science, PubMed, Ovid Embase and the Cochrane Library, were systematically searched, and some studies were supplemented by key authors and reference lists.Study selectionThirty-one studies were identified, involving 1069 surgical patients enrolled in the ERAS programme. The inclusion and exclusion criteria were formulated based on the Population, Interest of phenomena, Context, Study design criteria recommended by the Joanna Briggs Institute to determine the scope of article retrieval. The inclusion criteria were as follows: ERAS patients' experiences; qualitative data; English language and published from January 1990 to August 2021.Data extractionData were extracted from relevant studies using the standardised data extraction tool from Joanna Briggs Institute Qualitative Assessment and Review Instrument for qualitative research.Data synthesisThe themes in the structure dimension are as follows: (1) patients cared about the timeliness of healthcare professionals' help; (2) patients cared about the professionalism of family care; and (3) patients misunderstood and worried about the safety of ERAS. The themes in the process dimension are as follows: (1) patients needed adequate and accurate information from healthcare professionals; (2) patients needed to communicate adequately with healthcare professionals; (3) patients hoped to develop a personalised treatment plan and (4) patients required ongoing follow-up services. The theme in the outcome dimension is as follows: patients wanted to effectively improve severe postoperative symptoms.ConclusionsEvaluating ERAS from the patient's perspective can reveal the omissions and deficiencies of healthcare professionals in clinical care so that problems in patients' recovery process can be solved in a timely manner, reducing potential barriers to the implementation of ERAS.Prospero registration numberCRD42021278631.
| S-EPMC9945048 | biostudies-literature