Laparoscopic gastric surgery in an enhanced recovery programme.
BACKGROUND
Laparoscopy is associated with less pain and organ dysfunction than open surgery. Improved perioperative care (enhanced recovery programmes, fast-track methodology) has also led to reduced morbidity and a shorter hospital stay. The effects of a combination of laparoscopic resection and accelerated recovery have not been examined previously in the context of gastric surgery.


METHODS
This was a prospective study of 32 consecutive patients undergoing laparoscopic gastric resection combined with an enhanced recovery protocol (early oral intake, no drains or nasogastric tubes, no epidural analgesia, use of a urinary catheter for less than 24 h and planned discharge 72 h after surgery). Outcomes included length of hospital stay, intraoperative and postoperative complications, readmission rate and 30-day mortality.


RESULTS
Operative procedures were elective distal or subtotal gastrectomy (22 patients) and total gastrectomy (10). Median length of hospital stay was 4 (range 2-30) days. There were two major complications: postoperative bleeding requiring reoperation and pulmonary embolism. Two patients required readmission, one for a wound abscess and one for treatment of a urinary tract infection. There were no deaths within 30 days.


CONCLUSIONS
Minimally invasive gastrectomy with enhanced postoperative recovery results in a short hospital stay and low morbidity rate.
Grantcharov
T P
TP
Division of General Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. grantcharovt@smh.toronto.on.ca
Kehlet
H
H
D000230:Adenocarcinoma / Q000534:rehabilitation / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000534:rehabilitation*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000534:rehabilitation*; D015397:Program Evaluation; D011446:Prospective Studies; D020127:Recovery of Function; D013274:Stomach Neoplasms / Q000534:rehabilitation / Q000601:surgery*