婦人科腹腔鏡下手術のERAS（enhanced recovery after surgery）導入にむけた前向き研究

抄録

Objective: This study evaluated the advantages and disadvantages of the enhanced recovery after surgery (ERAS) clinical pathways and those traditionally used in the gynecological field for introducing the ERAS protocols in patients scheduled to undergo gynecological laparoscopy.

Methods: This was a prospective, randomized, controlled trial comprising women (18–75 years old) with benign gynecological disease who were scheduled to undergo laparoscopic surgery in June–September 2019. Patients who provided consent were randomly assigned to the traditional or ERAS group with the approval of the ethics committee of our hospital. A postoperative questionnaire and nursing and surgical records of the two groups were then evaluated.

Results: Consent was obtained from 191 patients (89 and 102 patients in the traditional and ERAS groups, respectively). The ERAS group reported shorter time for first postoperative defecation than the traditional group (p = 0.02). The number of physicians who had slight difficulty in performing surgical manipulation on ERAS group patients was significantly higher (p = 0.01). However, the ERAS protocols were successfully implemented in other settings.

Conclusion: Physicians had slight difficulty in performing surgical manipulation on ERAS group patients. However, since no periprocedural complications occurred, it can be assumed that laparoscopic surgery for benign disease was safely performed. Additionally, ERAS protocol in laparoscopic surgery enables the shortening of fasting period and duration of feeling queasy and relieves the patients from the discomfort associated with laxative use, making it more easily acceptable by the patients.