Fast Track Surgery-Minimizing Side Effects of Surgery.

Abstract

BSurgery leaves scars not only on the body but mind as well^ has been known for long [1]. Human civilization has progressed with paralleled evolution of technology and its application in surgical science. Surgery was once seen merely as a life-saving option. It has progressed from life to limb saving with function preservation and further to being cytoprotective or cyto-preservative [2]. Surgeons have been, used to setting the agenda for defining their own outcomes, enjoying a fiducial relationship with their patients. This therapeutic privilege and the fulcrum of social pedestal occupied by surgeons is undergoing a change in this era of Binformed consent^ [3]. The social perceptions of surgeons are suspect, given the dichotomy between the choices we make for ourselves and choices we offer to our patients [4]. In addition to Bclinical outcome^-based perspective, patient’s perceptionbased perspective is gaining currency [5, 6]. Patient reported outcomes (PROs) are driving the current march of surgical sciences [7]. The PROs are not only addressing the need for the precision and perfection in clinical outcomes but are bordering at zero tolerance for adverse events, calling at making them Bnever events^ [8, 9].Much of the PRO-related recovery can be defined as the components of postoperative recovery or postoperative convalescence. Postoperative convalescence relates to the patient-reported recovery after the surgeonexpected clinical outcome has been optimized. This is akin to the side effects of medicine alluded to by Sir Osler. It would not be an exaggeration to call the PRO-based postoperative convalescence as the Bside effects of surgery.^ It is this side effect of surgery which defines the return to normal, for the surgical patient, and determines the final health-related quality of life (HrQoL). Abdominal surgery in an index area for the surgeon. Abdominal surgery is distinct from other regions in creating an autonomic wound in addition to the somatic wound [10]. The somatic wound innervated by the thoracolumbar nerves works through the posterior column of spinal cord. The effects of this can be clinically controlled by regional blocks, preemptive analgesia, etc. Minimally, invasive surgery has minimized the somatic wound and should have neutralized the impediment to convalescence absolutely. But, the evidence has been to contrary, in a setting of level 1 designed study for colorectal operations [11]. It is therefore the importance of autonomic wound of abdominal surgery that needs to be considered. The peritoneum, a functional and metabolic omnipresent structure in abdomen, conveys sensations through the largest visceral nerve in the body, i.e., vagus, directly to brain through autonomic pathways. It has distinct nociceptors which at times are unresponsive, i.e., Bsilent nociceptors^ which respond only during an insult such as surgery. In addition to inflammatory cascade of somatic wound, this autonomic wound-mediated inflammation has a tremendous capacity for downstream amplification [12]. The complex interplay of somatic and autonomic wound-mediated inflammatory cascade has been in * Chintamani drchintamani7@gmail.com