INTRODUCTION: Despite constantly evolving surgical techniques focused on reducing tissue trauma during surgery, innovations in anesthesia, major colorectal resections continue to be associated with significant perioperative morbidity, which is associated by prolonged hospital stay and high cost of treatment. In order to explain the complications after operation, the mechanisms of pathophysiological changes due to surgical stress must be understood. At the end of the 1990s, components of the so-called fast-track rehabilitation program aimed to achieve early recovery after major surgery. These protocols eliminate old understandings of postoperative recovery and put into practice evidence-based principles and innovations aimed at reducing physiological stress and postoperative organ dysfunction through optimization of perioperative care and recovery.
AIM: The aim of this article is to analyze the current recommendations for good clinical practice and the postulates of accelerated recovery protocols in minimally invasive colorectal surgery.
MATERIALS AND METHODS: The evidence in the modern literature on the methods of enhanced recovery after minimally invasive colorectal surgery was reviewed. Our experience with 152 minimally invasive colorectal resections was discussed.
RESULTS: Results published in the literature regarding postoperative recovery and morbidity using ERP were analyzed. The results of a personal study of 152 minimally invasive colorectal resections are reported. The perioperative complication rate was 13.8%, with a median hospital stay of 5.9 days, and perioperative mortality rate of 1.3%.
CONCLUSION: Implementation of evidence-based methods of preparation, perioperative monitoring, and postoperative care and rehabilitation are associated with significantly better outcomes in terms of perioperative complications and postoperative recovery.
Greer NL, Gunnar WP, Dahm P, Lee AE, MacDonald R, Shaukat A, et al. Enhanced recovery protocols for adults undergoing colorectal surgery: a systematic review and meta-analysis. Dis Colon Rectum. 2018;61(9):1108–18. doi: 10.1097/DCR.0000000000001160.
Visioni A, Shah R, Gabriel E, Attwood K, Kukar M, Nurkin S. Enhanced recovery after sur- gery for noncolorectal surgery?: a systematic review and meta-analysis of major abdominal surgery. Ann Surg. 2018;267(1):57–65. doi: 10.1097/SLA.0000000000002267.
Lau CS, Chamberlain RS. Enhanced recovery after surgery programs improve patient outcomes and recovery: a meta-analysis. World J Surg. 2017;41(4):899–913. doi: 10.1007/s00268-016-3807-4.
SAGES SMART Enhanced Recovery Program. Available from: https://www.sages.org/smart-enhanced-recovery-program/.
Alawadi ZM, Leal I, Phatak UR, Flores-Gonzalez JR, Holihan JL, Karanjawala BE, et al. Facilitators and barriers of implementing enhanced recovery in colorectal surgery at a safety net hospital: a provider and patient perspective. Surgery. 2016;159(3):700–12. doi: 10.1016/j.surg.2015.08.025.
Kiran RP, Murray AC, Chiuzan C, Estrada D, Forde K. Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anasto- motic leak, and ileus after colorectal surgery. Ann Surg. 2015;262(3):416–25. doi: 10.1097/SLA.0000000000001416.
Klinger AL, Green H, Monlezun DJ, Beck D, Kann B, Vargas HD, et al. The role of bowel preparation in colorectal surgery: results of the 2012-2015 ACS-NSQIP Data. Ann Surg. 2019;269(4):671–7. doi: 10.1097/SLA.0000000000002568.
Gillis C, Li C, Lee L, Awasthi R, Augustin B, Gamsa A, et al. Prehabilitation versus reha- bilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology. 2014;121(5):937–47. doi: 10.1097/ALN.0000000000000393.
Carli F, Zavorsky GS. Optimizing functional exercise capacity in the elderly surgical population. Curr Opin Clin Nutr Metab Care. 2005;8(1):23–32. doi: 10.1097/00075197-200501000-00005.
Barberan-Garcia A, Ubré M, Roca J, Lacy AM, Burgos F, Risco R, et al. Personalised preha- bilitation in high-risk patients undergoing elective major abdominal surgery: a randomized blinded controlled trial. Ann Surg. 2018;267(1):50–6. doi: 10.1097/SLA.0000000000002293.
Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg. 2017;152(3):292–8. doi: 10.1001/jamasurg.2016.4952.
Yang Z, Zheng Q, Wang Z. Meta-analysis of the need for nasogastric or nasojejunal decompression after gastrectomy for gastric cancer. Br J Surg. 2008;95(7):809-16. doi: 10.1002/bjs.6198.
Liu X, Wang D, Zheng L, Mou T, Liu H, Li G. Is early oral feeding after gastric cancer surgery feasible? A systematic review and meta-analysis of randomized controlled trials. PLoS One. 2014;9(11):e112062. doi: 10.1371/journal.pone.0112062.
Maessen J, Dejong CH, Hausel J, Nygren J, Lassen K, Andersen J, et al. A protocol is not enough to implement an enhanced recovery programme for colorectal resection. Br J Surg. 2007;94(2):224-31. doi: 10.1002/bjs.5468.
Email this article (Login required) 
