Effect of restrictive versus liberal fluid therapy for laparoscopic gastric surgery on postoperative complications: a randomized controlled trial.

Abstract

Purpose: Currently, laparoscopic surgery is a standard technique in the field of abdominal surgery. However, the most adequate fluid regimen during laparoscopic surgery remains unclear. The aim of this trial is to compare a restricted fluid therapy with a liberal fluid therapy for laparoscopic abdominal surgery. Our hypothesis was that restrictive fluid therapy would reduce postoperative complications better than liberal fluid therapy.

Method: In this randomized controlled trial, patients scheduled for laparoscopic gastric surgery were randomized to either the liberal group (receiving 7-10 ml/kg/h of crystalloid) or the restrictive group (receiving 1-2 ml/kg/h of crystalloid) for each stratum of surgical procedure from April 2017 to March 2019. For both groups, blood loss was replaced by an equal volume of hydroxyethyl starch. The primary endpoint was postoperative complications up to 30 days after surgery, according to the Clavien-Dindo classification.

Results: We enrolled 148 patients, and 140 of these were randomized to either the liberal or the restrictive group after exclusion. As a result, 69 cases were included in the liberal group for analysis, and 67 patients composed the restrictive group. Median fluid administration for the liberal and restrictive groups was 2950 ml and 800 ml, respectively. As well, overall complications in the liberal and restrictive groups were 27.5% and 19.4%, respectively (risk ratio 0.71, 95% confidence interval 0.38-1.31, p value = 0.264).

Conclusion: Restricted fluid therapy and liberal fluid therapy did not show any statistical differences in postoperative complications after laparoscopic gastric surgery.