Perioperative Management of Laparoscopic Splenic Surgery and Application of Enhanced Recovery After Surgery (ERAS)

Enhanced recovery after surgery (ERAS) is a new therapeutic concept emerging with the introduction and application of the model of bio-psycho-social medicine. It refers to a series of perioperative optimized treatment measures based on evidence-based medical evidence. Perioperative period refers to the whole process around the surgery, from the time when the patient decides to undergo surgery to the time of basic rehabilitation, including the period before, during, and after the operation. Specifically, it refers to the period from the decision of operative treatment, until the end of the treatment related to the operation, about 5–7 days before the surgery to 7–12 days after the surgery [1]. Along with the treatment of the patients, ERAS requires to reduce the patient’s traumatic stress reaction and their complications and to accelerate the patient rehabilitation as much as possible. The concept of ERAS was first proposed by Danish surgeon Kehlet [2] in 1997, and it has been gradually applied to various surgical fields, including gastrointestinal surgery, obstetrics and gynecology, urology, orthopedics, cardiothoracic surgery, and so on [3–6]. Nevertheless, splenic surgery has not been made independent from hepatobiliary and pancreatic surgery, so the application of ERAS in splenic surgery is rarely mentioned separately. On the other hand, since Delaitre et al. [7] completed the world’s first laparoscopic splenectomy (LS) in 1991, LS has been increasingly applied in the treatment of various benign and malignant splenic diseases due to the advantages of small trauma, rapid recovery, and short postoperative hospitalization, and its safety and effectiveness have been increasingly recognized [8, 9]. Currently, LS has become the first choice for the treatment of surgical diseases of normal to medium-sized spleen. Therefore, we refer to the existing literature and guidelines and introduce the application of ERAS concept in laparoscopic splenic surgery based on the clinical practice of our center.