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Laparoscopy vs fast track

Laparoscopy vs fast track. H.Pernthaler, 1.Chirurgie, Bozen. Cleveland Clinic Florida, 1992. Results of fast-track compared with traditional surgery • Reduced duration of ileus • Improved muscle strength, exercise capacity, or lean body mass • Improved oral energy and protein intake

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Laparoscopy vs fast track

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  1. Laparoscopy vs fast track H.Pernthaler, 1.Chirurgie, Bozen

  2. Cleveland Clinic Florida, 1992

  3. Results of fast-track compared with traditional surgery • Reduced duration of ileus • Improved muscle strength, exercise capacity, or lean body mass • Improved oral energy and protein intake • Decreased cardiopulmonary morbidity • Reduced hospital stay • No effect on rate of readmissions • Decreased period of postoperative convalescence • Reduced costs Kehlet, Lancet Volume 371, Issue 9615, 8 March 2008-14 March 2008, Pages 791-793

  4. Evidence-based methods • Obtain preoperative information on patients and optimise organ dysfunction • Epidural analgesia or non-opioid multimodal analgesia • Avoidance of fluid excess or use of goal-directed therapy • No preoperative bowel clearance • No routine use of drains • No routine use of nasogastric tubes • Early oral feeding and mobilisation • Consider preoperative carbohydrate administration • Well-defined daily care maps or discharge criteria Kehlet, Lancet Volume 371, Issue 9615, 8 March 2008-14 March 2008, Pages 791-793

  5. TABLE 3. Duration of Surgery, Transfusion, Hospitalization, and Readmissions in 60 Patients Randomized to Open or Laparoscopic Colonic Resection (* = P < 0.05 Between Groups) From:   Basse: Ann Surg, Volume 241(3).March 2005.416-423

  6. Care after colonic operation- ist it evidence based? Results from a multimodal survey in Europe and the US, Kehlet H, Büchler RW, Beart RW Jr, Billingham RP, Williamson R J Am Coll Surg 2006, 202: 45-54 • 295 hospitals, 1,082 Patients, 2 weeks postop. • Preop. bowel clearance > 85% • nasogastric tube in situ 40% EU 66% US 3-4 pod • liquids after 3-4 days 50% • Postop ileus 45% for 5 days • Discharge mean 10 days EU, 7 days US, 2-5 days fast track trials

  7. Laparoscopic colonic surgery in Denmark 2004-2007Schulze S, Colorectal Dis 2008 in press • 1149 procedures without stoma • 25 departments, 4 departments > 100 procedures • Median postop d: 4 (mean 7.7) • Readmission within 30 days: 10.9% • Mortality: 3.5% postop, 2.6% 30 days

  8. Notfall Offen laparoskopisch Rektum 0 13 2 Abdominoperineal 2 1 Sigma 3 7 Hemikolektomie sx 11 6 3 Hemikolektomie dx 1 17 Kolektomie 2 Erweiterte Eingriffe 5 Res. Mit anderen Eingriffen 4 14 50 13 Dickdarmresektionen 2007, 1.Chirurgie,laparoskopisch: 31.7% der potentiellen Indikationen, 0 Konversionen

  9. Conclusions laparoscopy/fast track • Both laparoscopic colon resection and fast track surgery improve recovery and reduce hospital stay • Large scale studies are required on potential differences in serious morbidity and mortality • A protocol is not enough

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