Effectiveness of the concept of fast-trak surgery for simultaneous laparoscopic hernioplastics and cholecistectomy
Abstract
The aim of the research was to study the feasibility and effectiveness of simultaneous laparoscopic hernioplasty and cholecystectomy in patients with combined abdominal pathology.
Material and methods. Simultaneous laparoscopic hernioplasty and cholecystectomy during 2015–2019 performed on 70 patients, including 49 (70 %) women, mean age 57.3 ± 6.5 g. In 37 patients the principles of Fast-track surgery were applied (group I), including thorough examination for diagnostics of combined abdominal pathology and clinically significant general somatic pathology; if necessary a course of therapy for full compensation of general somatic pathology was prescribed; during the operation of epidural prolonged anesthesia; choice in favor of laparoscopic technology; at the end of the operation – irrigation of the subdiaphragmatic space with local anesthetic; postoperatively: early drainage removal; withdrawal from opioids by prescribing parenteral paracetomol; activation of the patient 6-8 hours after surgery; on the day of surgery – use of chewing gum and fluid intake. In 33 patients the standard complex of perioperative management (group II) is applied. The immediate results of surgical interventions have been studied.
Results. There were no significant complications during the operation and in the early postoperative period. In the first group, seroma (after open alloplasty) was detected in 2 (5 %) cases, and in the second group, small wound complications were detected in 4 (12 %) cases (p > 0.05 according to the χ2 criterion). The duration of inpatient treatment in patients of group I is 4.4 ± 1.2 months, in group II – 7.0 ± 1.3 days (р < 0.001 by Student’s test).
Conclusion. Application of the principles of Fast-track surgery and accelerated recovery at all stages of simultaneous laparoscopic hernioplasty and cholecystectomy (preparation for surgery, during the operation and in the postoperative period) does not increase the number of postoperative complications and decreased duration of inpatient treatment from 7,0 ± 1,3 in patients with traditional postoperative management to 4,4 ± 1,2 days.
Downloads
References
St John A, Caturegli I, Kubicki NS, Kavic SM. The Rise of Minimally Invasive Surgery: 16 Year Analysis of the Progressive Replacement of Open Surgery with Laparoscopy. JSLS. 2020 Oct-Dec; 24 (4):e2020.00076. https://doi.org/10.4293/JSLS.2020.00076
Galimov OV, Khanov VO, Mamadaliyev DZ, Sayfullin RR, Sagitdinov RR. Kreativnaya khirurgiya gryzhi pishchevodnogo otverstiya diafragmy. Khirurgiya. 2017; 7: 30–32. https://doi.org/10.17116/hirurgia2017730-32
Rakhmatullayev RR, Rakhmatullayev AR, Khasanov SM, Ibragimov SHB. Simul'tannyye operatsii iz yedinogo laparoskopicheskogo dostupa. Vestnik Akademii meditsinskikh nauk Tadzhikistana. 2017; 1: 77–79
Shakya VC. Simultaneous laparoscopic management of Morgagni hernia and cholelithiasis: two case reports. BMC Res Notes. 2015; Jul 1; 8: 283. https://doi.org/10.1186/s13104-015-1249-y
Semonov VV, Kurygin AlA. Simul’tannyye operatsii na organakh zhivota: spornyye i ochevidnyye aspekty problemy. Vestnik khirurgii. 2014; 173 (6): 96–99.
Kiriyenko AI, Nikishkov AS, Seliverstov YEI, Andriyashkin AV. Epidemiologiya gryzh peredney bryushnoy stenki. Endoskopicheskaya khirurgiya. 2016; 4: 55–60 https://doi.org/10.17116/endoskop201622455-60
Henriksen NA. Systemic and local collagen turnover in hernia patients. Dan Med J. 2016; Jul; 63 (7). pii: B5265
Rodrigues G, Ravi Ch, Prabhu R. Fast-track surgery: A new concept of perioperative management of surgical patients. Journal of Health Specialties. 2013; 1 (3): 114–121
Nanavati AJ, Prabhakar S. A comparative study of 'fast-track' versus traditional peri-operative care protocols in gastrointestinal surgeries. J Gastrointest Surg. 2014; Apr; 18 (4): 757–67. https://doi.org/10.1007/s11605-013-2403-2
Jurt J, Slieker J, Frauche P, Addor V, Solà J, Demartines N, Hübner M. Enhanced recovery after surgery: can we rely on the key factors or do we need the bel ensemble? World J Surg. 2017;Oct;41(10):2464-2470. https://doi.org/10.1007/s00268-017-4054-z
Slim K, Standaert D. Enhanced recovery after surgical repair of incisional hernias. Hernia. 2020 Feb;24(1):3-8. https://doi.org/10.1007/s10029-019-01992-y
Stearns E, Plymale MA, Davenport DL, Totten C, Carmichael SP, Tancula CS, Roth JS. Early outcomes of an enhanced recovery protocol for open repair of ventral hernia. Surg Endosc. 2018;Jun;32(6):2914-2922. https://doi.org/10.1007/s00464-017-6004-0
Ueland W, Walsh-Blackmore S, Nisiewicz M, Davenport DL, Plymale MA, Plymale M et al. The contribution of specific enhanced recovery after surgery (ERAS) protocol elements to reduced length of hospital stay after ventral hernia repair. Surg Endosc. 2020 Oct; 34 (10): 4638–4644. https://doi.org/10.1007/s00464-019-07233-8
Gelman D, Gelmanas A, Urbanaitė D, Tamošiūnas R, Sadauskas S, Bilskienė D, et al. Role of Multimodal Analgesia in the Evolving Enhanced Recovery after Surgery Pathways. Medicina (Kaunas).2018; Apr 23; 54 (2): 20. https://doi.org/10.3390/medicina54020020
McGlory G, Davis AE, Kirksey KM. Multimodal analgesia in critical care. Nursing Critical Care. 2018; 13 (2): 18–23.
Kahokehr A, Sammour T, Soop M, Hill AG. Intraperitoneal use of local anesthetic in laparoscopic cholecystectomy: Systematic review and metaanalysis of randomized controlled trials. 2010; Sep; 17 (5): 637–656
Ge W, Chen G, Ding YT. Effect of chewing gum on the postoperative recovery of gastrointestinal function. Intern J Clin Experim Med. 2015; 8 (8): 11936–11942
The Journal of V. N. Karazin Kharkiv National University, series Medicine has following copyright terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work’s authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal’s published version of the work, with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
