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World Journal of Surgery
Published in: World Journal of Surgery 10/2016

01-10-2016 | Original Scientific Report

Enhanced Recovery Pathway for Right and Left Colectomy: Comparison of Functional Recovery

Authors: Anne Kummer, Juliette Slieker, Fabian Grass, Dieter Hahnloser, Nicolas Demartines, Martin Hübner

Published in: World Journal of Surgery | Issue 10/2016

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Abstract

Background

Enhanced recovery (ERAS) guidelines do not differentiate between left- and right-sided colectomies, but differences in recovery have been reported for the two procedure types. We aimed to compare compliance with the ERAS protocol and outcomes after right versus left colectomy.

Methods

Between June 2011 and September 2014, all patients undergoing elective colonic resection were treated according to a standardized ERAS protocol and entered a prospective database. This retrospective analysis compared right and left colectomy regarding application of the ERAS pathway, bowel recovery, complications, and hospital stay.

Results

Eighty-five patients with right colectomy matched well with 138 left-sided resections for baseline demographics. Overall compliance with the ERAS protocol was 76 % for right versus 77 % for left colectomy patients (p = 0.492). First flatus occurred at postoperative day 2 in both groups (p = 0.057); first stool was observed after a median of 3 (right) and 2 days (left), respectively (p = 0.189). Twenty patients (24 %) needed postoperative nasogastric tube after right colectomy compared to 11 patients (8 %) after left colectomy (p = 0.002). Overall complication rates were 49 and 37 % for right and left colectomy, respectively (p = 0.071). Median postoperative length of stay was 6 days (IQR 4–9) after right and 5 days (IQR 4–7.5) after left colectomy (p = 0.020).

Conclusion

Overall compliance with the protocol was equally high in both groups showing that ERAS protocol was applicable for right and left colectomy. Functional recovery however, tended to be slower after right colectomy, and postoperative ileus rate was significantly higher. More cautious early feeding after right colectomy should be considered.
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Metadata
Title
Enhanced Recovery Pathway for Right and Left Colectomy: Comparison of Functional Recovery
Authors
Anne Kummer
Juliette Slieker
Fabian Grass
Dieter Hahnloser
Nicolas Demartines
Martin Hübner
Publication date
01-10-2016
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 10/2016
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-016-3563-5

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