Abstract
Aims: Studies that recommend laparoscopic right hemicolectomies within an Enhanced Recovery After Surgery (ERAS) programme are based on data from all types of colorectal procedures. This study compares short-term outcomes following right hemicolectomies within an ERAS setting. Methods: Retrospective analysis of elective right hemicolectomies carried out between October 2008 and April 2012. Exclusion criteria:- patients not managed with an ERAS programme; inflammatory bowel disease; ASA IV and above; extended right hemicolectomy; formation of a stoma. Patients were split into laparoscopic (Group A) and open procedure (Group B). Patient demographics, hospital stay, operative details, tumour characteristics, analgesia usage and complications were compared between the two groups. Discharge criteria was standardised for both groups. Significance was taken as p <0.05. Results: 32 patients were included in Group A and 37 patients in Group B. No significant difference in terms of sex, mean age, ASA grade, tumour stage, lymph node yield and epidural usage. BMI was statistically higher in Group A (27.9 vs. 24,8 kg/m2). Four laparoscopic procedures were converted to open. There were two anastomotic leaks in group B. No significant difference in complication rates. Median post-operative stay for Group A was significantly less at 5 days compared to 7 days for Group B. Patients in Group A also opened their bowels earlier (median day 4 vs. 5). Conclusions: Our study demonstrates that in the setting of ERAS, laparoscopic right hemicolectomies are associated with a shorter hospital stay without an increase in complication rate compared to the open method.
Highlights
Since the introduction of laparoscopic colorectal surgery in 1991, studies have demonstrated shorter hospital stay [1,2,3] reduced blood loss [4] and lower post-operative morbidity [5,6] compared to open procedures whilst oncological clearance [4,7] and long-term survival [8,9,10,11] have been comparable between the two.An important development in peri-operative management has been the use of the Enhanced Recovery After Surgery Programme (ERAS)
Studies advocating laparoscopic right hemicolectomies over open resections have not integrated the ERAS programme [9,22,23,24,25]. It remains unclear whether the benefits of laparoscopy combined with ERAS can be applied to right hemicolectomies
Our study demonstrates patients who underwent a laparoscopic right hemicolectomy within an ERAS setting had a significantly reduced postoperative stay compared to those that had an open procedure
Summary
An important development in peri-operative management has been the use of the Enhanced Recovery After Surgery Programme (ERAS) This protocol minimises disturbance of peri-operative physiology and aims to shorten hospital stay [12,13] by reducing pre-operative dehydration, encouraging mobilisation and commencing an oral diet from day one [14]. Randomised controlled trials have demonstrated that the benefits of laparoscopic colorectal surgery can be improved if these are carried in an ERAS setting [15,16,17,18]. These trials have included a heterogenous group of colorectal resections:- right, extended right, left, sigmoid and rectal [16,18,19]. It remains unclear whether the benefits of laparoscopy combined with ERAS can be applied to right hemicolectomies
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