Laparoscopy vs fast track H.Pernthaler, 1.Chirurgie, Bozen

Cleveland Clinic Florida, 1992

Results of fast-track compared with traditional surgery Reduced duration of ileus Improved muscle strength, exercise capacity, or lean body mass Improved oral energy and protein intake Decreased cardiopulmonary morbidity Reduced hospital stay No effect on rate of readmissions Decreased period of postoperative convalescence Reduced costs Kehlet, Lancet Volume 371, Issue 9615, 8 March March 2008, Pages Volume 371, Issue 9615

Evidence-based methods Obtain preoperative information on patients and optimise organ dysfunction Epidural analgesia or non-opioid multimodal analgesia Avoidance of fluid excess or use of goal-directed therapy No preoperative bowel clearance No routine use of drains No routine use of nasogastric tubes Early oral feeding and mobilisation Consider preoperative carbohydrate administration Well-defined daily care maps or discharge criteria Kehlet, Lancet Volume 371, Issue 9615, 8 March March 2008, Pages Volume 371, Issue 9615

TABLE 3. Duration of Surgery, Transfusion, Hospitalization, and Readmissions in 60 Patients Randomized to Open or Laparoscopic Colonic Resection (* = P < 0.05 Between Groups) From: Basse: Ann Surg, Volume 241(3).March

Care after colonic operation- ist it evidence based? Results from a multimodal survey in Europe and the US, Kehlet H, Büchler RW, Beart RW Jr, Billingham RP, Williamson R J Am Coll Surg 2006, 202: hospitals, 1,082 Patients, 2 weeks postop. Preop. bowel clearance > 85% nasogastric tube in situ 40% EU 66% US 3-4 pod liquids after 3-4 days 50% Postop ileus 45% for 5 days Discharge mean 10 days EU, 7 days US, 2-5 days fast track trials

Laparoscopic colonic surgery in Denmark Schulze S, Colorectal Dis 2008 in press 1149 procedures without stoma 25 departments, 4 departments > 100 procedures Median postop d: 4 (mean 7.7) Readmission within 30 days: 10.9% Mortality: 3.5% postop, 2.6% 30 days

Dickdarmresektionen 2007, 1.Chirurgie, laparoskopisch: 31.7% der potentiellen Indikationen, 0 Konversionen NotfallOffenlaparoskopisch Rektum0132 Abdominoperineal 21 Sigma 37 Hemikolektomie sx1163 Hemikolektomie dx117 Kolektomie2 Erweiterte Eingriffe 5 Res. Mit anderen Eingriffen

Conclusions laparoscopy/fast track Both laparoscopic colon resection and fast track surgery improve recovery and reduce hospital stay Large scale studies are required on potential differences in serious morbidity and mortality A protocol is not enough