Fast-track Rehabilitation After Elective Colorectal and Small Bowel Resection

Not Applicable

Completed

Brief Summary: The purpose of this study is to address the question of whether or not oral alimentation and ambulation exercise should be begun early in patients following laparoscopic colorectal surgery compared to the classical diet and ambulation which depends on reappearance of functional intestinal transit. Early oral alimentation following laparoscopic colorectal surgery may decrease hospital stay and facilitate earlier discharge with comparable postoperative morbidity.

Detailed Description: Traditionally, patients who received laparoscopic colorectal surgery were treated with the classical protocol including the use of a naso-gastric tube and starvation for several postoperative days till the recovery of bowel movement, or bed resting at immediate postoperative period followed by ward ambulation at the postoperative day 1 or 2. Restarting the oral alimentation is based on gas or feces reappearance after surgery and usually this is possible at several days following surgery. However, prolonged starvation might be uncomfortable for the patient as well as increasing his postoperative hospital stay. Recently, several studies reported the efficacy of early rehabilitation protocols after intestinal surgery, showing that early oral alimentation could reduce the length of hospital stay and cost of hospitalization without significant increase of postoperative complications, compared to traditional management.

This prospective, randomized study was designed to evaluate the effectiveness of a postoperative care pathway using rehabilitation with early ambulation and diet for patients undergoing elective laparoscopic colorectal resection compared with the traditional postoperative care.

In order to conduct this study, patients having a laparoscopic colon resection will be randomly attributed to enhanced recovery program group or control group, which is divided based on the postoperative management protocol.

Recruitment & Eligibility

Inclusion Criteria

• Patients between 20 - 80 years old
- Class ASA (American Society of Anesthesiology) I, II or III, +/- E
- Patient willing to participate in the study
- Patient who understands and accepts to sign the informed consent form
- Patient who will undergo elective colorectal resection using laparoscopic surgery defined as follows: patients who received one of the following surgery:right hemicolectomy, left hemicolectomy, anterior resection with primary anastomosis, and low anterior resection with loop ileostomy for fecal diversion

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
ERP group	fast-track rehabilitation	fast-track rehabilitation with early ambulation and diet after elective colorectal resection

Primary Outcome Measures

Name	Time	Method
the Length of Hospital Stay	at discharge	discharge criteria 1. Tolerance of consecutive 3 soft bland diet 2. Unassisted ambulation 3. No necessity of analgesics 4. Afebrile without major complication 5. Willing to discharge
Pain	at discharge	score measured by the Visual Analog Scale
Quality of Life	at discharge	measured by SF-36
Postoperative Complication During the First Admission	at discharge
Recovery	at discharge	recovery criteria must include all of the following 1. Tolerance of consecutive 3 soft bland diet 2. Unassisted ambulation 3. No necessity of analgesics 4. Afebrile without major complication

Secondary Outcome Measures

Name	Time	Method
Readmission Rate	at postoperative day 30
Pain	at postoperative day 30	score measured by the Visual Analog Scale
Quality of Life	at postoperative day 30	measured by SF-36
Postoperative Complication	at postoperative day 30

Locations (2): Sung-Bum Kang
🇰🇷
Seongnam, Korea, Republic of
Department of Surgery, Seoul National University Bundang Hospital
🇰🇷
Seongnam, Korea, Republic of