scholarly journals Laparoscopic Colorectal Surgery: Summary of the Current Evidence

2009 ◽  
Vol 91 (7) ◽  
pp. 541-544 ◽  
Author(s):  
Emad H Aly
Keyword(s):  
Colorectal Surgery ◽  
Enhanced Recovery ◽  
Laparoscopic Colorectal Surgery ◽  
Cost Effective ◽  
Current Evidence ◽  
Rectal Cancer Surgery ◽  
Port Site Recurrence ◽  
Medline Search ◽  
Recovery Protocols ◽  
Randomised Controlled

INTRODUCTION Laparoscopic colectomy has not been accepted as quickly as laparoscopic cholecystectomy. This is because of its steep learning curve, concerns with oncological outcomes, lack of randomised controlled trials (RCTs) and initial reports on port-site recurrence after curative resection. The aim of this review is to summarise current evidence on laparoscopic colorectal surgery. PATIENTS AND METHODS Review of literature following Medline search using key words ‘laparoscopic’, ‘colorectal’ and ‘surgery’. CONCLUSIONS Laparoscopic colorectal surgery proved to be safe, cost-effective and with improved short-term outcomes. However, further studies are needed to assess the role of laparoscopic rectal cancer surgery and the value of enhanced recovery protocols in patients undergoing laparoscopic colorectal resections.

scholarly journals A systematic review of enhanced recovery protocols in colorectal surgery

2011 ◽  
Vol 93 (8) ◽  
pp. 583-588 ◽  
Author(s):  
A Rawlinson ◽  
P Kang ◽  
J Evans ◽  
A Khanna
Keyword(s):  
Systematic Review ◽  
Colorectal Surgery ◽  
Perioperative Care ◽  
Enhanced Recovery ◽  
Hospital Readmissions ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Hand Search ◽  
Recovery Protocols ◽  
Randomised Controlled

INTRODUCTION Colorectal surgery has been associated with a complication rate of 15–20% and mean postoperative inpatient stays of 6–11 days. The principles of enhanced recovery after surgery (ERAS) are well established and have been developed to optimise perioperative care and facilitate discharge. The purpose of this systematic review is to present an updated review of perioperative care in colorectal surgery from the available evidence and ERAS group recommendations. METHODS Systematic searches of the PubMed and Embase™ databases and the Cochrane library were conducted. A hand search of bibliographies of identified studies was conducted to identify any additional articles missed by the initial search strategy. RESULTS A total of 59 relevant studies were identified. These included six randomised controlled trials and seven clinical controlled trials that fulfilled the inclusion criteria. These studies showed reductions in duration of inpatient stays in the ERAS groups compared with more traditional care as well as reductions in morbidity and mortality rates. CONCLUSIONS Reviewing the data reveals that ERAS protocols have a role in reducing postoperative morbidity and result in an accelerated recovery following colorectal surgery. Similarly, both primary and overall hospital stays are reduced significantly. However, the available evidence suggests that ERAS protocols do not reduce hospital readmissions or mortality. These findings help to confirm that ERAS protocols should now be implemented as the standard approach for perioperative care in colorectal surgery.

An Expanded Preoperative Component within an Enhanced Recovery Protocol Improves Outcomes in Colorectal Surgery

2017 ◽  
Vol 83 (8) ◽  
pp. 928-934
Author(s):  
Nathan M. Johnson ◽  
Sandy L. Fogel
Keyword(s):  
Colorectal Surgery ◽  
Length Of Stay ◽  
Enhanced Recovery ◽  
Statistical Significance ◽  
Current Evidence ◽  
P Value ◽  
Postoperative Length ◽  
Enhanced Recovery Protocol ◽  
Recovery Protocols ◽  
Colorectal Procedures

Enhanced Recovery Protocols (ERPs) have been shown to lead to quicker recovery in colorectal surgery, with reduced postoperative length of stay (LOS). ERPs could potentially be improved with an expanded preoperative component reflecting current evidence. We hypothesize that an ERP with an expanded preoperative component will reduce LOS consistent with or exceeding that seen with traditional ERPs. Our ERP was implemented in June of 2014. Data was collected for two full years from July 2014 through June 2016. The protocol was employed in colorectal cases, both elective and emergent. Data from ERP cases were compared with contemporaneous controls that did not go through the ERP. Patients who underwent colorectal procedures and participated in the ERP with the expanded preoperative component had an average LOS of 5.33 days, whereas controls stayed for an average of 7.93 days (P value, <0.01). ERP cases also experienced fewer read-missions and complications, although statistical significance could not be established. The results demonstrate that an ERP with an enhanced preoperative component significantly reduces LOS and potentially decreases the rate of readmissions and total complications.

Elderly Patients Benefit From Enhanced Recovery Protocols After Colorectal Surgery

2021 ◽  
Vol 266 ◽  
pp. 54-61
Author(s):  
Jessica Y Liu ◽  
Sebastian D Perez ◽  
Glen G Balch ◽  
Patrick S Sullivan ◽  
Jahnavi K Srinivasan ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Elderly Patients ◽  
Enhanced Recovery ◽  
Recovery Protocols

scholarly journals Robotic colorectal surgery: more than a fantastic toy?

2018 ◽  
Vol 3 (1) ◽  
pp. 65-68 ◽  
Author(s):  
James W.T. Toh ◽  
Kevin Phan ◽  
Seon-Hahn Kim
Keyword(s):  
Rectal Cancer ◽  
Colorectal Surgery ◽  
Da Vinci Surgical System ◽  
Current Evidence ◽  
Rectal Cancer Surgery ◽  
Cancer Trial ◽  
Robotic Colorectal Surgery ◽  
Significant Difference ◽  
Meta Analyses ◽  
Laparoscopic Assisted

AbstractThere has been a rapid rise in the number of robotic colorectal procedures worldwide since the da Vinci Surgical System robotic technology was approved for surgical procedures in the year 2000. Several recent meta-analyses and systematic reviews have shown a significant difference in outcomes between robotic and laparoscopic rectal cancer surgery. However, these results from pooled data have not been supported by the initial results reported from the Robotic assisted versus laparoscopic assisted resection for rectal cancer trial. In this article, we examine the current evidence for robotic colorectal surgery, assess its features and functionality, evaluate its learning curve and provide our perspective on its future.

scholarly journals Operative Time and Outcome of Enhanced Recovery After Surgery After Laparoscopic Colorectal Surgery

2014 ◽  
Vol 18 (2) ◽  
pp. 265-272 ◽  
Author(s):  
Oliver J. Harrison ◽  
Neil J. Smart ◽  
Paul White ◽  
Adela Brigic ◽  
Elinor R. Carlisle ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Operative Time ◽  
Enhanced Recovery ◽  
Laparoscopic Colorectal Surgery ◽  
Enhanced Recovery After Surgery

Goal-directed Fluid Therapy Does Not Reduce Primary Postoperative Ileus after Elective Laparoscopic Colorectal Surgery

2017 ◽  
Vol 127 (1) ◽  
pp. 36-49 ◽  
Author(s):  
Juan C. Gómez-Izquierdo ◽  
Alessandro Trainito ◽  
David Mirzakandov ◽  
Barry L. Stein ◽  
Sender Liberman ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Fluid Therapy ◽  
Postoperative Ileus ◽  
Enhanced Recovery ◽  
Laparoscopic Colorectal Surgery ◽  
Enhanced Recovery After Surgery ◽  
Therapy Group ◽  
Control Group ◽  
Goal Directed Fluid Therapy ◽  
The Impact

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.

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