[Value of laparoscopic surgery in elective colorectal surgery with "fast-track"-rehabilitation].
BACKGROUND
Laparoscopic (LAP) versus open (CON) colonic resection with traditional perioperative care has some short term benefits postoperatively regarding functional recovery. Whether these benefits may also occur when all patients are treated with multimodal "fast-track"-rehabilitation programs is questionable.


METHODS
Patients undergoing elective left sided colonic surgery were prospectively non randomised observed. The "fast-track" program included patient information, thoracic peridural analgesia, forced mobilisation and oral intake, and stress reduction. Endpoints were duration of postoperative ileus and hospital stay, general- and local complication, and pulmonary function.


RESULTS
147 consecutive patients were operated on, 47 open and 100 laparoscopically. The time until oral intake was completed seemed to be shorter in the LAP-group (p=0.07) followed by a shorter hospital stay (p<0.01). The pulmonary function was postoperatively improved in the LAP-group compared to the CON-group (p<0,01). General complications (LAP 9% vs. CON 17%) were non significantly increased in the CON-group. Local complications increased in the CON-group (LAP 13% vs. CON 28%, p<0,05).


CONCLUSIONS
Even with perioperative "fast-track"-rehabilitation programs short term advantages were found in laparoscopic compared with open colonic surgery in a non randomised population. The clinical relevance should be examined in controlled randomised trials.
Junghans
T
T
Universitätsklinik für Allgemein-, Visceral-, Gefäss- und Thoraxchirurgie, Universitätsmedizin Berlin, Charité Campus Mitte, Berlin. tido.junghans@charite.de
Raue
W
W
Haase
O
O
Neudecker
J
J
Schwenk
W
W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000601:surgery*; D012809:Colon, Sigmoid / Q000601:surgery; D015179:Colorectal Neoplasms / Q000534:rehabilitation* / Q000601:surgery*; D003289:Convalescence; D003627:Data Interpretation, Statistical; D004238:Diverticulitis / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications; D020127:Recovery of Function; D012007:Rectum / Q000601:surgery