The Enhanced Recovery After Surgery model of perioperative care targets the
obstacles to recovery following major abdominal surgery: pain, gastrointestinal
dysfunction and immobility. This model of care combines elements that have
individually been shown to attenuate the surgical stress response, reduce
postoperative analgesia requirement or maintain perioperative nutrition. Through
combining these elements it has been possible to improve early postoperative function
and reduce the requirement for hospital stay with an unaltered or even reduced
complication rate.Within the available ERAS studies subjective postoperative outcomes are employed
and it is difficult to assess the true contribution of many of the individual protocol
elements to postoperative recovery. The reduction in length of stay, in itself, may
represent more efficient use of inpatient care rather than an improved rate of
functional recovery. Further refinement and validation of the ERAS model will be
achieved by establishing randomised controlled trials that test its feasibility and
effectiveness within other surgical specialties, establish objective, reproducible
outcome measures and examine the specific contribution of individual protocol
elements within the ERAS protocol. It is expected that further improvement in
postoperative recovery may specifically rely on reducing gut dysfunction in the early
postoperative period. The establishment of randomised controlled trials and objective
endpoints will facilitate testing individual element that target gastrointestinal
recoveryThis thesis demonstrates that the application of an ERAS model of care to hepatic
surgery is feasible and results in a reduction in postoperative stay similar to that seen
in colorectal surgery. This suggests that the ERAS programme of care may be
extrapolated to other surgical specialties. The present thesis also demonstrates that
activity meters and stable isotope gastric empting breath tests can be employed in the
early postoperative period to provide objective measures of postoperative recovery.
Most significantly this thesis demonstrates through a randomised controlled trial that
within an ERAS protocol early routine administration of laxatives can improve
postoperative rate of gastrointestinal recovery following hepatic resection
