Background: Morbidity post hepatectomy still remain persistent throughout decades compared to other
surgery. Modern approach have been introduced to improve safety and reduce morbidity whilst at the same
time enhance patient recovery. Thus, enhanced recovery after surgery or fast track recovery program for
liver resection was initiated.
Objective: The aim of this study was to achieve discharge by postoperative
day 3 for minor resection and day 5 for major resection.
Design and Setting: This is a prospective study
conducted in Hospital Universiti Kebangsaan Malaysia (HUKM) from September 2014 till April 2015.
Material
and Methods: All patients undergoing open liver resection were included in the study. They were then
managed post operatively according to ERAS protocol that was drawn up based on previous studies. Patient’s
demographics data, intra operative parameters, postoperative complications and adherence to
postoperative recovery protocol were recorded.
Results: Seventeen patients (7 major and 10 minor
resection) were recruited. The mean length of hospital stay for minor resection was 5.9 and major resection
was 9.6 .With regards to the targets, 4 out of 10 (40%)patients in minor resection group and 4 out 7 (57.1%)
in the major group were discharged on time. 9 patients had postoperative complications with no mortality
recorded. In terms of the ERAS protocol targets, the PCA morphine discontinuation target was achieved in
15 patients (88.3%) ,nasogastric tube removal (13 patients -76.5%) , urinary cathether removal (6 patients -
35.3%), abdominal drains removal (9 patients-52.9%) and resumption of full diet was achieved by 82.4% (14
patients).
Conclusion: From these overall achievement, most of our targets have been met and this shows
that our ERAS protocol is safe to be applied to patient undergoing hepatectomy.
Limitations: Some patients
had achieved their target but not discharged for unknown reason.