Sitzung

83 - Freie Mitteilung
HPB
3. Juni 2022, 08:30 - 10:00, Szenario 2

Abstract

1
Systematic review of enhanced recovery after pancreatic surgery
F. Bergfelder1, P. Probst1, M. Baechtold1, P. Renzulli2, F. Hauswirth2, M. K. Muller1, Presenter: F. Bergfelder1 (1Frauenfeld, 2Münsterlingen)

Objective
The concept of “fast track surgery” was first implemented in the 90’s. Later enhanced recovery after surgery (ERAS) concepts were established also for pancreatic surgery. These contain specific preoperative counselling, nutritional therapy, epidural analgesia, perioperative iv-fluid restriction, avoidance or early removal of tubes, drains and catheters, early mobilization and early oral feeding. The aim of this systematic review was to summarize the evidence for the potential benefit regarding postoperative outcomes in pancreatic surgery.
Methods
Systematic literature search was performed in CENTRAL, Medline and Web of Science without language restrictions. Randomized controlled trials (RCT) investigating any kind of enhanced recovery program in pancreatic surgery were included. Postoperative outcomes were analysed with a random-effects model by either the Mantel-Haenzsel or inverse variance method. Cochrane RoB 2.0 tool and GRADE approach was used for assessment of risk of bias and certainty of evidence.
Results
Finally, six randomized controlled trials (RCT) with 646 patients were included. The risk of delayed gastric emptying was significantly reduced in the ERAS group (odds ratio 0.44; 95%-CI: 0.28 to 0.69; p<0.01; certainty of evidence: moderate). Likewise length of hospital stay was shortened by about 3 days (95%-CI: -5.7 to -0.2 day; p=0.03; certainty of evidence: low). Mortality, postoperative complications like pancreatic fistula, intra-abdominal fluid collections, bile leak or post-pancreatectomy hemorrhage were not altered by the ERAS concept (certainty of evidence: moderate to low).
Conclusion
After pancreatic surgery, the ERAS protocol results in shortened length of hospital stay and less delayed gastric emptying. Mortality or postoperative morbidity were not affected by the ERAS concept.
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