Intraoperative surgical considerations for enhanced recovery after elective colonic surgery

SUMMARY Careful planning of the intraoperative stage of the surgical stay plays an important role in achieving progress through the perioperative component of a multimodal care pathway. This period will play a significant part of the patient’s hospital experience and may dictate the ability to achieve the postoperative targets of an enhanced recovery program. A review of the available evidence demonstrates where benefits can be made to contribute to the overall progress of the patient’s recovery. Elements considered include: wound siting and care, minimal access techniques, use of diathermy, insertion of drains and catheters, and aspects of surgical techniques. These areas, when combined as part of an ‘enhanced recovery after surgery’ program, should contribute to a more rapid patient recovery without any increase in complications.