The present systematic review shows that , with the exception of laparoscopic surgery , objective evidence of the effect of individual components of ERAS protocol s in reducing the stress response following colorectal surgery is limited
Abstract Enhanced Recovery or Fast Track Recovery after Surgery protocol s ( ERAS ) have significantly changed perioperative care following colorectal surgery and are promoted as reducing the stress response to surgery .
A Prospective, Randomized, Controlled Trial Comparing Intermittent Portal Triad Clamping Versus Ischemic Preconditioning With Continuous Clamping for Major Liver Resection
Objective : To evaluate whether ischemic preconditioning ( IP ) with continuous clamping or intermittent clamping ( IC ) of the portal triad confers better protection during liver surgery . Summary Background Data : IP and IC are distinct protective approaches against ischemic injury . Since both strategies proved to be superior in r and omized controlled trials ( RCTs ) to continuous inflow occlusion alone , we design ed a RCT to compare IP and IC in patients undergoing major liver resection . Methods : Noncirrhotic patients undergoing major liver resection were r and omized to receive IP with inflow occlusion ( n = 36 ) or IC ( n = 37 ) . Primary endpoints were postoperative liver injury and intraoperative blood loss . Postoperative liver injury was assessed by peak values of AST ( alanine aminotransferase ) and ALT ( aspartate aminotransferase ) , as well as the area under the curve ( AUC ) of the postoperative transaminase course . Secondary endpoints included resection time , the need of blood transfusion , ICU , and hospital stay as well as postoperative complications and mortality . Results : Both groups were comparable regarding demographics , ASA score , type of hepatectomy , duration of inflow occlusion ( range , 30–75 minutes ) , and resection surface . The transection-related blood loss was 146 versus 250 mL ( P = 0.008 ) , and when st and ardized to the resection surface 1.2 versus 1.8 mL/cm2 ( P = 0.01 ) for IP and IC , respectively . Although peak AST , AUCAST , and AUCALT were lower for IC , the differences did not reach statistical significance . Overall ( 42 % vs. 38 % ) and major ( 33 vs. 27 % ) postoperative complications as well as median ICU ( 1 vs. 1 day ) and hospital stay ( 10 vs. 11 days ) were similar between both groups . Conclusions : Both IP and IC appear to be equally effective in protecting against postoperative liver injury in noncirrhotic patients undergoing major liver resection . However , IP is associated with lower blood loss and shorter transection time . Therefore , both strategies can be recommended for noncirrhotic patients undergoing liver resection
The present systematic review shows that , with the exception of laparoscopic surgery , objective evidence of the effect of individual components of ERAS protocol s in reducing the stress response following colorectal surgery is limited
Abstract Enhanced Recovery or Fast Track Recovery after Surgery protocol s ( ERAS ) have significantly changed perioperative care following colorectal surgery and are promoted as reducing the stress response to surgery .