Enhanced recovery programmes and colorectal surgery: does the laparoscope confer additional advantages?

BACKGROUND: Enhanced recovery after surgery (ERAS) protocols aim to reduce postoperative lengths of stay (LOS). Laparoscopic surgery shares the same objective. Whether or not laparoscopic surgery conveys additional benefits over and above those achievable with ERAS alone is unclear. METHOD: A review of the literature from January 1966 to June 2008 was performed. Randomized trial and case series investigating the role of laparoscopic surgery within ERAS protocols were included. These were assessed for LOS, readmissions, return of gut function, quality of life and cost of treatment. RESULTS: Four publications from three randomized trials and another seven case series were identified. Two randomized trials revealed no difference in the LOS and readmission rates between ERAS when used alone and ERAS with the inclusion of laparoscopic surgery. However, a third trial revealed a significantly shorter LOS and a lower readmission rate in the ERAS and laparoscopic group. CONCLUSION: The limited evidence presently available suggests that no further benefit is obtained by the inclusion of laparoscopic surgery in ERAS protocols. Further research is needed to derive more definitive conclusions.