Laparoscopic-assisted and open high anterior resection within an ERASprotocol. -Aprospective cohort study

P105

Gustafsson, U.
Kressner, M.
Thorell, A.
Ljungqvist, O.
Nygren, J.

¹Department of Surgery, Ersta Hospital, Karolinska Institute, Stockholm, Sweden,²Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden,³Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden,⁴O rebro University and University Hospital, Orebro, Sweden,⁵Institute of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden

Colorectal Disease 12:p 41, September 2010.

Aim:

In parallel with the laparoscopic development, enhanced recovery after surgery (ERAS)programs are shown to improve postoperative recovery in open colo-rectal surgery. This study reports adherence to the ERAS-protocol and outcomes in laparoscopic and open surgery.

Method:

The association between surgical approach, compliance to the ERAS-protocol, postoperative symptoms, complications and length of stay following surgery was studied. Between January 2007-December 2009, ninety-six consecutive patients underwent high anterior resection with laparoscopic-assisted (n = 49) or open resection (n = 47). All clinical data, (114 variables) wereprospectively recorded.

Results:

The overallpreoperative ERAS-protocol compliance was 82.7% in the laparoscopic group compared to 86.8% in the open group (P < 0.155). There was no significant difference in postoperative complications 10.2% vs 14.9%, OR 0.69 (95% CI 0.16-3.02), overall postoperative symptoms delaying recovery 22.4% vs 27.7%, OR 0.63 (95% CI 0.22-1.79) or median hospital stay (4 vs 5 days) in patients undergoing laparoscopic vs. open resection. Theproportion of patients within target length of stay £3 was larger in the laparoscopic group, 13 (26.5%) vs 5 (10.6) OR = 0.29 (95% CI 0.09-0.96).

Conclusion:

An ERAS setting facilitates the evaluation of laparoscopic colorectal surgery byproviding close audit and a firm framework for the perioperativeprocess.