Enhanced recovery after surgery programs hasten recovery after colorectal resections

Abstract

Colorectal resection was traditionally associated with significant morbidity and prolonged stay in hospital. Laparoscopic colorectal resection was first described in 1991 as a minimally invasive form of colorectal surgery. It was later on assessed by multiple randomized controlled trials and meta-analysis and was found to be associated with a faster recovery, lower complication rates and a shorter stay in hospital compared with open resection. To assess the effect of enhanced recovery after surgery (ERAS) program on postoperative length of stay after elective colorectal resections, a literature review was conducted, supplemented by the results of 111 ERAS colorectal resections at regional NWS Hospital using a protocol based on the Fast Track approach described by Kehlet in 1999. ERAS has been shown to improve postoperative recovery, reduce length of stay and enhance early return to normal function when compared with traditional colorectal surgical protocols. The role of laparoscopic surgery in colorectal resections within a fast-track (ERAS) program is controversial. The current evidence suggests that within such a program, there is no difference between laparoscopic and open colorectal surgery in terms of postoperative recovery rates or length of hospital stay.

Effects of an Enhanced Recovery After Surgery programme on emergency surgical patients

“…ERAS principles have long been established in elective major abdominal surgical patients . From the first descriptions in colonic surgery, there has been ‘diffusion’ or ‘metastasis’ to rectal surgery and other specialities .…”

Peri-Operative Care in Colorectal Surgery in the Twenty-First Century

“…However, subsequent larger studies reported a median length of stay of about five days, three days longer than what was reported in the first series (Abraham & Albayati, 2011;Nygren et al, 2009). Multiple published trials and systematic reviews have reported that ERAS protocols were associated with a faster recovery, reduced primary and overall lengths of hospital stay and complication rates after colorectal resections compared with the traditional approach.…”

“…In 1999, in a series of 16 open colectomies, the authors reported using a Fast Track (Enhanced Recovery after Surgery (ERAS)) Program with a median postoperative length of hospital stay of two days (Kehlet & Mogensen, 1999). However, subsequent larger studies reported a median length of stay of about five days (Abraham & Albayati, 2011). ERAS programs challenge the conventional approaches to peri-operative care in colorectal surgery in an evidence-based manner.…”

Accelerated postoperative rehabilitation: multidisciplinary issue. Part 1

“…Кроме того, в этих группах не вы-явлено различий объема желудочного содержимого и его рН [8]. Это мнение было подтверждено в по-следующих публикациях [6]. В настоящий момент рекомендации ERAS предусматривают прекраще-ние приема твердой пищи за 6 ч до операции, а жид-костей -за 2 ч [15].…”