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Laparoscopic-assisted and open high anterior resection within an ERAS protocol
Department of Surgery, Ersta Hospital, Stockholm, Sweden; Karolinska Institutet, Stockholm, Sweden; Centre for Gastrointestinal Disease, Ersta Hospital, Stockholm, Sweden.
Department of Surgery, Ersta Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Surgery, Ersta Hospital, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Surgery, Örebro University Hospital, Örebro, Sweden; Institute of Molecular Medicine and surgery, Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0003-2636-4745
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2012 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 36, no 5, p. 1154-1161Article in journal (Refereed) Published
Abstract [en]

Background: Due to potentially superior short-term outcomes compared with open colorectal surgery, laparoscopic surgery is currently being implemented in clinical practice worldwide. In parallel, enhanced recovery after surgery (ERAS) programs are shown to improve postoperative recovery in open colorectal surgery. This study reports outcomes in laparoscopic versus open surgery in conjunction with compliance to the ERAS protocol.

Methods: The association between surgical approach (laparoscopic or open surgery), compliance to the ERAS protocol, postoperative symptoms, complications, and length of stay after surgery was studied. Between January 2007 to December 2010, 114 consecutive patients underwent elective high anterior resection with laparoscopic-assisted (n = 55) or open resection (n = 59). All clinical data (114 variables) were prospectively recorded.

Results: The overall preoperative ERAS-protocol compliance was 77% for both the laparoscopic and open group. Laparoscopic surgery resulted in shorter total length of stay (median 4 vs. 6 days, p = 0.04), earlier pain control (median 2 vs. 3 days, p = 0.008), shorter need for intravenous infusions, improved mobilization on the first postoperative day (POD1), and lower inflammatory response (CRP (POD1) 54 +/- 24 vs. 67 +/- 31 mg/l, p = 0.017) compared with open resection. The trends in fewer postoperative complications (9.1 vs. 16.9%; odds ratio (OR) 0.55; 95% confidence interval (CI) 0.17-1.81) and overall postoperative symptoms delaying recovery (20 vs. 30.5%; OR 0.63; 95% CI 0.22-1.34) in laparoscopic surgery were not statistically significant.

Conclusions: The use of laparoscopy in colorectal surgery within an ERAS protocol results in faster recovery compared with open resection.

Place, publisher, year, edition, pages
New York, USA: Springer, 2012. Vol. 36, no 5, p. 1154-1161
National Category
Medical and Health Sciences Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-23359DOI: 10.1007/s00268-012-1519-yISI: 000304096700031PubMedID: 22395344Scopus ID: 2-s2.0-84863722075OAI: oai:DiVA.org:oru-23359DiVA, id: diva2:532303
Funder
Swedish Research CouncilStockholm County CouncilTorsten Söderbergs stiftelseThe Karolinska Institutet's Research Foundation
Note

Funding Agency:

Familjen Erling-Persson's Foundation 

Available from: 2012-06-11 Created: 2012-06-11 Last updated: 2017-12-07Bibliographically approved

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Ljungqvist, Olle

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