Researchers from Hvidovre, Denmark, combined laparoscopically-assisted colonic resection with a perioperative multimodal rehabilitation protocol.
Laparoscopic resection was intended in 50 consecutive patients, of median age 81 years. However 22 per cent were converted to open resection.
Rehabilitation protocol consisted of:
- Pain relief.
- Early mobilization.
- Oral nutrition.
After surgery, patients were treated with epidural local anaesthesia for 2 days, early mobilization, and enteral nutrition. The routine use of morphine and traditional tubes, drains, and prolonged bladder catheterization was avoided.
When the procedure was completed laparoscopically, the median hospital stay was 2·5 days, and defecation occurred in 92 per cent of patients within 3 days. From Day 2, patients were mobilized for more than 8 hours daily.
The team found that recovery from colonic surgery improved considerably by combining the use of a laparoscopic technique with a multimodal rehabilitation protocol of pain relief, early mobilization, and oral nutrition.
Dr L. Bardram said, "In the past, specific attention has not been paid to changes in perioperative protocols required to maximize the advantages of the minimally invasive procedure."