Enhanced recovery program in hepatobiliary surgery: experimental and clinical assessment

Materials and methods . The experiment was performed on 20 male Chinchilla rabbits. The authors studied the effectiveness of various types of nutritional support in resection of the left lateral lobe of the liver. A comparative analysis was based on the results of treatment of 1275 patients with acute and chronic diseases of the liver and biliary tract, 659 (51.7%) of which corresponded to the Fast Track program, and 616 (48.3%) were the control group. Results. The duration of inpatient treatment was reduced from 13.4 ± 4.2 to 9.3 ± 3.0 days ( t = 2.08; p = 0.04), and hospital mortality decreased from 0.8% to 0.45% ( p = 0.12). The postoperative morbidity fell from 4.2% to 3.2%, in particular, the proportion of III–V grade complications (Clavien–Dindo classification) reduced from 48.4% to 19.0% ( t = 2.34, p = 0.025). Conclusion . Clinical implementation of main Fast Track components in the early perioperative period in diseases of the liver and biliary tract reliably optimizes postoperative rehabilitation and reduces the incidence of postoperative complications. First promising results of this program suggest the need to correct traditional stereotypes ingrained in treatment programs for patients with hepatobiliary diseases, in order to improve the results of surgeries.