ERP Protocols in Minimally Invasive Colorectal Surgery

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.