Using the ERAS Concept as an Evolution of the Fast Track Surgery Program for Safe Elective Surgical Treatment of Primary Progressive Chronic Vein Disease During Pregnancy

Abstract

Objective: To date, therapeutic tactics for primary symptomatic chronic disease of sphere and/or non-sphere veins during pregnancy remain the subject of discussion. There are no generally accepted approaches to the choice of therapy methods, especially indications for planned surgical treatment.

Material and Methods: Surgical treatment of 457 pregnant women in the second and third trimesters with primary symptomatic chronic disease of
saphenous (large and / or small saphenous veins) of clinical class C2-4s, Er, As, p, Rg (according to the classification of the basis of CEAP, 2002) and / or
non-saphene veins (varicose veins of the inguinal canal, and/or vulva, and perineum) was carried out in a planned manner according to the ERAS program. The most important thing in this program is a multidisciplinary approach to the observation of pregnant women, hospitalization of them in a specialized obstetric hospital on the day of surgery, the use of perinatal psychotherapy to prepare the pregnant woman and fetus for surgery, performed by a vascular surgeon - the so-called “obstetric vascular surgeon”.

Results: As a result of the study, all operated patients noted that the use of the ideology of the ERAS program for planned surgical treatment of pregnant women with primary symptomatic chronic disease of saphene and/or non-saphene veins required the implementation of general and adaptation of some of its components to this contingent of patients, scrupulous adherence to them at all stages (before, during and after) of surgery. These factors contributed to the achievement of clinical effectiveness planned surgical treatment 97% in the absolute absence of complications from the fetus and mother in all operated
patients, protected against premature birth, caused a decrease in the number and severity of postoperative complications from postoperative wounds, which did not require additional treatment, did not affect the development of the fetus, the course of pregnancy.

Conclusion: This ensured the safety of childbirth and the postpartum period, formed comfortable conditions for the course of pregnancy in the postoperative period with a reduction in the period of stay in the hospital and the patient’s return to a normal lifestyle as soon as possible.

All operated patients did not need medical support in the postoperative and postpartum periods, except for the use of elastic knitwear of compression class 2 (stockings or knee-highs) during physical exertion.