Updates in surgery
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The ERAS® represents a dynamic culmination of upon perioperative care elements, successfully applied to different surgical specialties with shorter hospital stay and lower morbidity rates. The aim of this study is to describe the introduction of the ERAS protocol in colorectal surgery in our hospital analysing our first series. Between September 2014 and June 2016, 120 patients suffering from colorectal diseases were included in the study. ⋯ No 30-day readmission and no perioperative mortality were recorded. At the univariate analysis, the presence of complications was the only predictive factor for prolonged hospital stay (p < 0.001). In our experience, implementation of ERAS protocol for colorectal surgery allows a significant reduction of hospital stay improving perioperative management and postoperative outcomes.
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To reduce post-hepatectomy liver failure (PHLF), associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been recently developed for patients with a limited future remnant liver (FRL). Nevertheless, high morbi-mortality rates have been reported. The current study aimed to analyze the kinetics of FRL function in patients who were offered ALPPS. ⋯ Notably, the increase in FRL function between ALPPS stages [+12.5% (4.2-28.6%)] was lower than the volumetric gain [+42.6% (18.3-110.2%)] and inferior to that observed after one-stage major hepatectomy [+41.7% (-38.6 to +158.33%)]. This resulted in a drop of the FRL intrinsic liver function in ALPPS patients, of whom one died from PHLF. Our study enhances the importance of assessing liver function along with volume during ALPPS procedure and supports HBS as a suitable and reliable method, including a valuable contribution to determine most appropriate stage 2 surgical timing.