Failure of enhanced recovery after surgery in laparoscopic colorectal surgery: a systematic review

2020 ◽  
Vol 35 (6) ◽  
pp. 1007-1014
Author(s):  
Si-Da Sun ◽  
Ping-Ping Wu ◽  
Jun-Feng Zhou ◽  
Jia-Xing Wang ◽  
Qing-Liang He
Author(s):  
Oliver J. Harrison ◽  
Neil J. Smart ◽  
Paul White ◽  
Adela Brigic ◽  
Elinor R. Carlisle ◽  
...  

2017 ◽  
Vol 127 (1) ◽  
pp. 36-49 ◽  
Author(s):  
Juan C. Gómez-Izquierdo ◽  
Alessandro Trainito ◽  
David Mirzakandov ◽  
Barry L. Stein ◽  
Sender Liberman ◽  
...  

Abstract Background Inadequate perioperative fluid therapy impairs gastrointestinal function. Studies primarily evaluating the impact of goal-directed fluid therapy on primary postoperative ileus are missing. The objective of this study was to determine whether goal-directed fluid therapy reduces the incidence of primary postoperative ileus after laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. Methods Randomized patient and assessor-blind controlled trial conducted in adult patients undergoing laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. Patients were assigned randomly to receive intraoperative goal-directed fluid therapy (goal-directed fluid therapy group) or fluid therapy based on traditional principles (control group). Primary postoperative ileus was the primary outcome. Results One hundred twenty-eight patients were included and analyzed (goal-directed fluid therapy group: n = 64; control group: n = 64). The incidence of primary postoperative ileus was 22% in the goal-directed fluid therapy and 22% in the control group (relative risk, 1; 95% CI, 0.5 to 1.9; P = 1.00). Intraoperatively, patients in the goal-directed fluid therapy group received less intravenous fluids (mainly less crystalloids) but a greater volume of colloids. The increase of stroke volume and cardiac output was more pronounced and sustained in the goal-directed fluid therapy group. Length of hospital stay, 30-day postoperative morbidity, and mortality were not different. Conclusions Intraoperative goal-directed fluid therapy compared with fluid therapy based on traditional principles does not reduce primary postoperative ileus in patients undergoing laparoscopic colorectal surgery in the context of an Enhanced Recovery After Surgery program. Its previously demonstrated benefits might have been offset by advancements in perioperative care.


Medicine ◽  
2018 ◽  
Vol 97 (35) ◽  
pp. e12137 ◽  
Author(s):  
Corrado Pedrazzani ◽  
Cristian Conti ◽  
Guido Mantovani ◽  
Eduardo Fernandes ◽  
Giulia Turri ◽  
...  

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R Aseem ◽  
E Cribb ◽  
F Liccardo ◽  
N Daulatzai ◽  
J Smith ◽  
...  

Abstract Introduction Length of stay (LOS) following colorectal surgery has reduced due to enhanced recovery after surgery (ERAS) programs. Telemedicine has shown potential for patients to remotely access support, communicate progress with their medical team and enhance patient empowerment. We conducted a systematic review of smartphone applications for ERAS following colorectal surgery measuring patient outcomes and experience. Method The review was performed adhering to PRISMA guidelines, using search terms pertaining to ERAS, colorectal surgery, and mobile applications via electronic databases. All peer-reviewed English articles were assessed for inclusion and quality by two reviewers. A qualitative analysis was conducted to evaluate methodologies, patient experience, and outcomes. Results 206 abstracts were identified from which 5 articles (2 RCTs and 3 cohorts) were included in the analysis. Studies surveyed patient adherence to ERAS, LOS, readmission, intra and postoperative complications. Four studies recorded patient satisfaction, whilst one assessed quality of life and application validation. Conclusions The review highlights paucity in the use of smartphone applications after ERAS in colorectal surgery but demonstrates high patient satisfaction levels. Service delivery in the NHS has increasingly moved to a virtual platform during the coronavirus pandemic. More research and engagement in the development and use of smartphone applications would enhance care for patients.


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