Laparoscopy and fast-track peri-operative program improves colonic transit
MedWire News: Laparoscopic surgery and a program of fast-track peri-operative care significantly improves gastrointestinal transport after colonic surgery, research shows.
Laparoscopic surgery and fast-track care were both "significant predictors of improved colonic transit and reduced time to tolerance of solid food and bowel movement," report Guy Boeckxstaens (Catholic University of Leuven, The Netherlands) and colleagues in the journal Gastroenterology.
Postoperative side effects of colonic surgery include delayed gastrointestinal transit, and this is a major determinant of recovery following the surgical procedure. In addition, postoperative ileus is the single largest cause of increased hospital stays after abdominal surgery.
Minimally invasive laparoscopic surgery and fast-track peri-operative care have been shown to reduce hospital stays with earlier recovery of gastrointestinal function by reducing surgical stress response, organ dysfunction, and morbidity.
To date, however, objective measures supporting faster gastrointestinal recovery with fast-track care are lacking.
In the present study, Boeckxstaens and colleagues randomly assigned 93 patients to receive one of four treatments: laparoscopic surgery and standard peri-operative care; laparoscopic surgery and fast-track multimodal management; conventional surgery and standard care; or conventional surgery and fast-track management.
The fast-track program includes a multidisciplinary approach involving dieticians, nurses, surgeons, and anesthesiologists. The program focuses on adequate peri-operative fluid management, optimized analgesia, early oral nutrition, and early mobilization.
Using scintigraphy to assess gastric emptying and colonic transport from days 1 to 3 after surgery, the researchers demonstrated that median colonic transit of patients undergoing laparoscopy and fast-track care was significantly faster compared with the other three treatment arms.
The median time until first defecation and tolerance of solid food was also significantly shorter for patients who underwent laparoscopy and fast-track clinical care, than for patients in the other treatment groups.
The average length of stay in the laparoscopic/fast-track arm was 3.9 days compared with 5.9 days in the conventional surgery/fast-track arm and 6.0 days in the conventional surgery/standard care arm.
"These data suggest that laparoscopic resection and fast-track care lead to faster recovery of gastrointestinal transit after colorectal surgery," conclude the investigators.
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