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 .
Application of Fibrin Glue Sealant After Hepatectomy Does Not Seem Justified: Results of a Randomized Study in 300 Patients
Objective : To evaluate the efficacy , amount of hemorrhage , biliary leakage , complications , and postoperative evolution after fibrin glue sealant application in patients undergoing liver resection . Summary Background Data : Fibrin sealants have become popular as a means of improving perioperative hemostasis and reducing biliary leakage after liver surgery . However , trials regarding its use in liver surgery remain limited and of poor method ologic quality . Patients and Methods : A total of 300 patients undergoing hepatic resection were r and omly assigned to fibrin glue application or control groups .  Characteristics and debit of drainage and postoperative complications were evaluated . The amount of blood loss , measurements of hematologic parameters liver test , and postoperative evolution ( particularly involving biliary fistula and morbidity ) was also recorded . Results : Postoperatively , no differences were observed in the amount of transfusion ( 0.15 ± 0.66 vs. 0.17 ± 0.63 PRCU ; P = 0.7234 ) or in the patients that required transfusion ( 18 % vs. 12 % ; P = 0.2 ) , respectively , for the fibrin glue or control group . There were no differences in overall drainage volumes ( 1180 ± 2528 vs. 960 ± 1253 mL ) or in days of postoperative drainage ( 7.9 ± 5 vs. 7.1 ± 4.7 ) . Incidence of biliary fistula was similar in the fibrin glue and control groups , ( 10 % vs. 11 % ) . There were no differences regarding postoperative morbidity between groups ( 23 % vs. 23 % ; P = 1 ) . Conclusions : Application of fibrin sealant in the raw surface of the liver does not seem justified . Blood loss , transfusion , incidence of biliary fistula , and outcome are comparable to patients without fibrin glue . Therefore , discontinuation of routine use of fibrin sealant would result in significant cost saving
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 .