Efficacy of the ERAS strategy in patients with type III–IV paraesophageal hernias

Authors

DOI:

https://doi.org/10.30978/GS-2024-3-29

Keywords:

type III—IV paraesophageal hernia, surgical treatment, laparoscopic approach, ERAS protocol, outcomes

Abstract

ERAS (Enhanced Recovery After Surgery) protocols have demonstrated efficacy across numerous surgical specialties; however, their effectiveness has not been evaluated in patients with paraesophageal hernias (PEH).

Objective — to determine the efficacy of the ERAS strategy in patients with type III—IV PEH undergoing laparoscopic surgery.

Materials and methods. The study was conducted at the Department of General Surgery No 2 of Bogomolets National Medical University from 2017 to 2023, involving 114 patients who underwent laparoscopic hernioplasty for Type III—IV PEH. The ERAS strategy was applied in 96 patients (main group — Group M) and not applied in 18 patients (comparison group — Group C). The efficacy of the ERAS protocol was evaluated by comparing average hospital stay, hunger, thirst, general weakness, and depression levels using a 10‑point visual analogue scale (0=«no concern,» 10=«severe concern»), as well as the frequency of nausea, vomiting, abdominal distention, passage of gas, and bowel movement within the first postoperative day.

Results. Group M showed lower average scores for «general weakness», «hunger», and «thirst» by factors of 1.43, 1.35, and 1.34, respectively, compared to Group C. The application of the ERAS protocol positively influenced bowel function recovery: on the first postoperative day, the proportion of patients with gas passage was higher in Group M than in Group C (78.1% vs. 55.6%), while the incidence of abdominal distention was lower (2.1% vs. 16.7%). Bowel movement was observed in 51.0% of patients in Group M compared to 27.8% in Group C. These positive outcomes associated with the ERAS protocol contributed to a reduced average hospital stay of 1.72±0.76 days compared to 2.33±0.91 days in the control group.

Conclusions. The use of the ERAS protocol in patients undergoing laparoscopic surgery for type III—IV paraesophageal hernia demonstrated significant advantages in the early postoperative period. Patients reported significantly less «general weakness», «feeling of hunger», and «feeling of thirst» compared to the control group. Improved bowel function recovery was recorded, evidenced by a higher proportion of patients with gas passage and bowel movements and a significantly lower proportion of patients with abdominal distension, as well as a reduced average length of hospital stay. The obtained results confirm the feasibility of implementing the ERAS protocol to improve postoperative recovery and reduce postoperative complications in patients with type III—IV paraesophageal hernia.

 

Author Biographies

O. Y. Ioffe, Bogomolets National Medical University

MD, Prof., Head of the Department of General Surgery No2

O. P. Stetsenko, Bogomolets National Medical University

Candidate of Medical Sciences, Associate Professor of the Department of General Surgery No2

L. Y. Markulan, Bogomolets National Medical University

PhD, Assoc. Prof.

T. A. Tarasov, Bogomolets National Medical University

Head of the Department of Diseases of a Surgical Profile University Clinic

References

Ban KA, Berian JR, Ko CY. Does Implementation of Enhanced Recovery after Surgery (ERAS) Protocols in Colorectal Surgery Improve Patient Outcomes? Clin Colon Rectal Surg. 2019 Mar;32(2):109-113. http://doi.org/10.1055/s-0038-1676475. Epub 2019 Feb 28. PMID: 30833859; PMCID: PMC6395090.

Chao L, Lin E, Kho K. Enhanced Recovery After Surgery in Minimally Invasive Gynecologic Surgery. Obstet Gynecol Clin North Am. 2022 Jun;49(2):381-395. http://doi.org/10.1016/j.ogc.2022.02.014. PMID: 35636815.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004 Aug;240(2):205-13. http://doi.org/10.1097/01.sla.0000133083.54934.ae. PMID: 15273542; PMCID: PMC1360123.

Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CH, Lassen K, Nygren J, Hausel J, Soop M, Andersen J, Kehlet H. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005 Jun;24(3):466-77. http://doi.org/10.1016/j.clnu.2005.02.002. Epub 2005 Apr 21. PMID: 15896435.

Jensen KK, Brondum TL, Harling H, Kehlet H, Jorgensen LN. Enhanced recovery after giant ventral hernia repair. Hernia. 2016 Apr;20(2):249-56. http://doi.org/10.1007/s10029-016-1471-0. Epub 2016 Feb 24. PMID: 26910800.

Jensen KK, Dressler J, Baastrup NN, Kehlet H, Jørgensen LN. Enhanced recovery after abdominal wall reconstruction reduces length of postoperative stay: An observational cohort study. Surgery. 2019 Feb;165(2):393-397. http://doi.org/10.1016/j.surg.2018.07.035. Epub 2018 Sep 6. PMID: 30195401.

Kehlet H. Enhanced recovery after surgery. Dan Med J. 2022 Nov 24;69(12):A09220536. PMID: 36458610.

Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008 Aug;248(2):189-98. http://doi.org/10.1097/SLA.0b013e31817f2c1a. PMID: 18650627.

Kitchin S, Raman VT, Javens T, Jatana KR. Enhanced Recovery After Surgery: A Quality Improvement Approach. Otolaryngol Clin North Am. 2022 Dec;55(6):1271-1285. http://doi.org/10.1016/j.otc.2022.07.011. PMID: 36371140.

Lassen K, Soop M, Nygren J, Cox PB, Hendry PO, Spies C, von Meyenfeldt MF, Fearon KC, Revhaug A, Norderval S, Ljungqvist O, Lobo DN, Dejong CH Enhanced Recovery After Surgery (ERAS) Group. Consensus review of optimal perioperative care in colorectal surgery: enhanced recovery after surgery (ERAS) group recommendations. Arch Surg. 2009;144:961-9. http://doi.org/10.1001/archsurg.2009.170.

Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP, Johnson F, Hongo M, Richter JE, Spechler SJ, Tytgat GN, Wallin L. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999 Aug;45(2):172-80. http://doi.org/10.1136/gut.45.2.172. PMID: 10403727; PMCID: PMC1727604.

Macedo FIB, Mittal VK. Does enhanced recovery pathways affect outcomes in open ventral hernia repair? Hernia. 2017 Oct;21(5):817-818. http://doi.org/10.1007/s10029-016-1553-z. Epub 2016 Nov 16. PMID: 27853863.

Melloul E, Lassen K, Roulin D, Grass F, Perinel J, Adham M, Wellge EB, Kunzler F, Besselink MG, Asbun H, Scott MJ, Dejong CHC, Vrochides D, Aloia T, Izbicki JR, Demartines N. Guidelines for Perioperative Care for Pancreatoduodenectomy: Enhanced Recovery After Surgery (ERAS) Recommendations 2019. World J Surg. 2020 Jul;44(7):2056-2084. http://doi.org/10.1007/s00268-020-05462-w. PMID: 32161987.

Nelson G, Fotopoulou C, Taylor J, Glaser G, Bakkum-Gamez J, Meyer LA, Stone R, Mena G, Elias KM, Altman AD, Bisch SP, Ramirez PT, Dowdy SC. Enhanced recovery after surgery (ERAS®) society guidelines for gynecologic oncology: Addressing implementation challenges - 2023 update. Gynecol Oncol. 2023 Jun;173:58-67. http://doi.org/10.1016/j.ygyno.2023.04.009. Epub 2023 Apr 21. PMID: 37086524.

Rollins KE, Lobo DN, Joshi GP. Enhanced recovery after surgery: Current status and future progress. Best Pract Res Clin Anaesthesiol. 2021 Dec;35(4):479-89. http://doi.org/10.1016/j.bpa.2020.10.001.

Saidian A, Nix JW. Enhanced recovery after surgery: Urology. Surg Clin North Am. 2018. Dec;98(6):1265-74. http://doi.org/10.1016/j.suc.2018.07.012.

Slim K, Theissen A. Enhanced recovery after elective surgery. A revolution that reduces post-operative morbidity and mortality. J Visc Surg. 2020 Dec;157(6):487-91. http://doi.org/10.1016/j.jviscsurg.2020.07.005.

Stenberg E, Dos Reis Falcão LF, O’Kane M, Liem R, Pournaras DJ, Salminen P, Urman RD, Wadhwa A, Gustafsson UO, Thorell A. Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update. World J Surg. 2022 Apr;46(4):729-51. http://doi.org/10.1007/s00268-021-06394-9.

Tazreean R, Nelson G, Twomey R. Early mobilization in enhanced recovery after surgery pathways: current evidence and recent advancements. J Comp Eff Res. 2022 Feb;11(2):121-9. http://doi.org/10.2217/cer-2021-0258.

Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr. 2010;29(4):434-40. https://doi.org/10.1016/j.clnu.2010.01.004.

Wilmore DW, Kehlet H. Management of patients in fast track surgery. BMJ. 2001 Feb 24;322(7284):473-6. http://doi.org/10.1136/bmj.322.7284.473. PMID: 11222424; PMCID: PMC1119685..

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Published

2024-10-08

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1.
Ioffe O, Stetsenko O, Markulan L, Tarasov T. Efficacy of the ERAS strategy in patients with type III–IV paraesophageal hernias. ЗХ [Internet]. 2024Oct.8 [cited 2024Dec.8];(3):29-36. Available from: http://generalsurgery.com.ua/article/view/314669

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Original Research