Goal-directed Fluid Therapy Does Not Reduce Primary Postoperative Ileus after Elective Laparoscopic Colorectal Surgery

2017 ◽  
Vol 127 (1) ◽  
pp. 36-49 ◽  
Author(s):  
Juan C. Gómez-Izquierdo ◽  
Alessandro Trainito ◽  
David Mirzakandov ◽  
Barry L. Stein ◽  
Sender Liberman ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Fluid Therapy ◽  
Postoperative Ileus ◽  
Enhanced Recovery ◽  
Laparoscopic Colorectal Surgery ◽  
Enhanced Recovery After Surgery ◽  
Therapy Group ◽  
Control Group ◽  
Goal Directed Fluid Therapy ◽  
The Impact

Abstract Background Inadequate perioperative fluid therapy impairs gastrointestinal function. Studies primarily evaluating the impact of goal-directed fluid therapy on primary postoperative ileus are missing. The objective of this study was to determine whether goal-directed fluid therapy reduces the incidence of primary postoperative ileus after laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. Methods Randomized patient and assessor-blind controlled trial conducted in adult patients undergoing laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. Patients were assigned randomly to receive intraoperative goal-directed fluid therapy (goal-directed fluid therapy group) or fluid therapy based on traditional principles (control group). Primary postoperative ileus was the primary outcome. Results One hundred twenty-eight patients were included and analyzed (goal-directed fluid therapy group: n = 64; control group: n = 64). The incidence of primary postoperative ileus was 22% in the goal-directed fluid therapy and 22% in the control group (relative risk, 1; 95% CI, 0.5 to 1.9; P = 1.00). Intraoperatively, patients in the goal-directed fluid therapy group received less intravenous fluids (mainly less crystalloids) but a greater volume of colloids. The increase of stroke volume and cardiac output was more pronounced and sustained in the goal-directed fluid therapy group. Length of hospital stay, 30-day postoperative morbidity, and mortality were not different. Conclusions Intraoperative goal-directed fluid therapy compared with fluid therapy based on traditional principles does not reduce primary postoperative ileus in patients undergoing laparoscopic colorectal surgery in the context of an Enhanced Recovery After Surgery program. Its previously demonstrated benefits might have been offset by advancements in perioperative care.

scholarly journals A Randomised Controlled Trial of Fluid Restriction Compared to Oesophageal Doppler-Guided Goal-Directed Fluid Therapy in Elective Major Colorectal Surgery within an Enhanced Recovery after Surgery Program

2014 ◽  
Vol 42 (6) ◽  
pp. 752-760 ◽  
Author(s):  
T. D. Phan ◽  
V. An ◽  
B. D'Souza ◽  
M. J. Rattray ◽  
M. J. Johnston ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Length Of Stay ◽  
Fluid Therapy ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Volume Index ◽  
Goal Directed Therapy ◽  
Major Complications ◽  
Number Of Patients ◽  
Goal Directed Fluid Therapy

There is continued controversy regarding the benefits of goal-directed fluid therapy, with earlier studies showing marked improvement in morbidity and length-of-stay that have not been replicated more recently. The aim of this study was to compare patient outcomes in elective colorectal surgery patients having goal-directed versus restrictive fluid therapy. Inclusion criteria included suitability for an Enhanced Recovery After Surgery care pathway and patients with an American Society of Anesthesiologists Physical Status score of 1 to 3. Patients were intraoperatively randomised to either restrictive or Doppler-guided goal-directed fluid therapy. The primary outcome was length-of-stay; secondary outcomes included complication rate, change in haemodynamic variables and fluid volumes. One hundred patients, 50 in each group, were included in the analysis. Compared to restrictive therapy, goal-directed therapy resulted in a greater volume of intraoperative fluid, 2115 (interquartile range 1350 to 2560) ml versus 1500 (1200 to 2000) ml, P=0.008, and was associated with an increase in Doppler-derived stroke volume index from beginning to end of surgery, 43.7 (16.3) to 54.2 (21.1) ml/m2, P <0.001, in the latter group. Length-of-stay was similar, P=0.421. The number of patients with any complication (minor or major) was similar; 60% (30) versus 52% (26), P=0.42, or major complications, 1 (2%) versus 4 (8%), P=0.36, respectively. The increased perioperative fluid volumes and increased stroke volumes at the end of surgery in patients receiving goal-directed therapy did not translate to a significant difference in length-of-stay and we did not observe a difference in the number of patients experiencing minor or major complications.

scholarly journals Operative Time and Outcome of Enhanced Recovery After Surgery After Laparoscopic Colorectal Surgery

2014 ◽  
Vol 18 (2) ◽  
pp. 265-272 ◽  
Author(s):  
Oliver J. Harrison ◽  
Neil J. Smart ◽  
Paul White ◽  
Adela Brigic ◽  
Elinor R. Carlisle ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Operative Time ◽  
Enhanced Recovery ◽  
Laparoscopic Colorectal Surgery ◽  
Enhanced Recovery After Surgery

PROPER—PRehabilitatiOn Plus Enhanced Recovery after surgery versus enhanced recovery after surgery in gynecologic oncology: a randomized clinical trial

2021 ◽  
pp. ijgc-2021-003170
Author(s):  
Andre Lopes ◽  
Alayne Magalhães Trindade Domingues Yamada ◽  
Thais de Campos Cardenas ◽  
Jaqueline Nunes de Carvalho ◽  
Emília de Azevedo Oliveira ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Functional Capacity ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Preoperative Care ◽  
Gynecologic Surgery ◽  
Calorie Intake ◽  
Control Group ◽  
Gynecological Surgery ◽  
The Impact

BackgroundPrehabilitation is a process that occurs before surgery and aims to improve patient functional capacity and enhance surgical recovery. This process includes medical, nutritional, physical, and psychological interventions that may reduce the duration of hospital stay and provide postoperative physical benefits.Primary ObjectiveTo evaluate the impact of a prehabilitation program on postoperative recovery time for patients who will undergo gynecological surgery following the Enhanced Recovery After Surgery (ERAS) guidelines.Study HypothesisA multidisciplinary, preoperative prehabilitation program for patients who will undergo gynecological surgery leads to a reduction in the length of hospital stay and improves patient functional capacity.Trial DesignProspective, interventionist, and randomized controlled trial in a 1:1 ratio, open to multidisciplinary team and patients, blinded to surgeons and anesthesiologists. The control group will undergo ERAS standard preoperative care while the intervention group will have ERAS standard preoperative care plus prehabilitation.Major Inclusion CriteriaPatients scheduled to undergo gynecologic surgery performed by laparotomy with a preoperative schedule that allows prehabilitation intervention for 2 to 3 weeks.Primary EndpointTo compare time between surgery and the day the patient is ready for discharge in patients who underwent the prehabilitation process versus those who did not. Readiness for discharge is defined as the ability to take care of one’s-self, to walk alone, and to ingest at least 75% of daily recommended calorie intake.Sample Size194 participantsEstimated Dates for Completing Accrual and Presenting ResultsAt present, 30 patients have been recruited. Accrual should be completed by 2023–24.Trial RegistrationThe study is approved by the IBCC – São Camilo Oncologia ethics committee (reference number 4.256.553) and is registered at clinicaltrials.gov (NCT04596800).

scholarly journals Impact of Enhanced Recovery after Surgery with Preoperative Whey Protein-Infused Carbohydrate Loading and Postoperative Early Oral Feeding among Surgical Gynecologic Cancer Patients: An Open-Labelled Randomized Controlled Trial

Nutrients ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 264 ◽  
Author(s):  
Ho Chiou Yi ◽  
Zuriati Ibrahim ◽  
Zalina Abu Zaid ◽  
Zulfitri ‘Azuan Mat Daud ◽  
Nor Baizura Md. Yusop ◽  
...  
Keyword(s):  
Whey Protein ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Gynecologic Cancer ◽  
Intervention Group ◽  
Oral Feeding ◽  
Control Group ◽  
Early Oral Feeding ◽  
Significant Difference ◽  
The Impact

Enhanced Recovery after Surgery (ERAS) with sole carbohydrate (CHO) loading and postoperative early oral feeding (POEOF) shortened the length of postoperative (PO) hospital stays (LPOHS) without increasing complications. This study aimed to examine the impact of ERAS with preoperative whey protein-infused CHO loading and POEOF among surgical gynecologic cancer (GC) patients. There were 62 subjects in the intervention group (CHO-P), which received preoperative whey protein-infused CHO loading and POEOF; and 56 subjects formed the control group (CO), which was given usual care. The mean age was 49.5 ± 12.2 years (CHO-P) and 51.2 ± 11.9 years (CO). The trial found significant positive results which included shorter LPOHS (78.13 ± 33.05 vs. 99.49 ± 22.54 h); a lower readmission rate within one month PO (6% vs. 16%); lower weight loss (−0.3 ± 2.3 kg vs. −2.1 ± 2.3 kg); a lower C-reactive protein–albumin ratio (0.3 ± 1.2 vs. 1.1 ± 2.6); preserved muscle mass (0.4 ± 1.7 kg vs. −0.7 ± 2.6 kg); and better handgrip strength (0.6 ± 4.3 kg vs. −1.9 ± 4.7 kg) among CHO-P as compared with CO. However, there was no significant difference in mid-upper arm circumference and serum albumin level upon discharge. ERAS with preoperative whey protein-infused CHO loading and POEOF assured better PO outcomes.

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