title: Faster recovery of gastrointestinal transit after laparoscopy and fast-track care in patients undergoing colonic surgery.
abstract: OBJECTIVE
  Postoperative ileus is characterized by delayed gastrointestinal (GI) transit and is a major determinant of recovery after colorectal surgery. Both laparoscopic surgery and fast-track multimodal perioperative care have been reported to improve clinical recovery. However, objective measures supporting faster GI recovery are lacking. Therefore, GI transit was measured following open and laparoscopic colorectal surgery with or without fast-track care.
  
  
  METHODS
  Patients (n = 93) requiring elective colonic surgery were randomized to laparoscopic or conventional surgery with fast-track multimodal management or standard care, resulting in 4 treatment arms. Gastric emptying and colonic transit were scintigraphically assessed from days 1 to 3 in 78 patients and compared with clinical parameters such as time to tolerance of solid food and/or bowel movement and time until (ready for) discharge.
  
  
  RESULTS
  A total of 71 patients without mechanical bowel obstructions or surgical complications requiring intervention were available for analysis. No differences in gastric emptying 24 hours after surgery between the different groups were observed (P = .61). However, the median colonic transit of patients undergoing laparoscopic/fast-track care was significantly faster compared with the laparoscopic/standard, open/fast-track, and open/standard care groups. Multiple linear regression analysis showed that both laparoscopic surgery and fast-track care were significant independent predictive factors of improved colonic transit. Both were associated with significantly faster clinical recovery and shorter time until tolerance of solid food and first bowel movement.
  
  
  CONCLUSIONS
  Colonic transit recovers significantly faster after laparoscopic surgery and the fast-track program; laparoscopy and fast-track care lead to faster recovery of GI motility and improve clinical recovery.
authors.affiliation: Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Sjoerd H W
authors.initials: SH
authors.lastname: van Bree
authors.forename: Sjoerd
authors.initials: S
authors.lastname: van Bree
authors.forename: Malaika S
authors.initials: MS
authors.lastname: Vlug
authors.forename: Malaika
authors.initials: M
authors.lastname: Vlug
authors.forename: Willem A
authors.initials: WA
authors.lastname: Bemelman
authors.forename: Willem
authors.initials: W
authors.lastname: Bemelman
authors.forename: Markus W
authors.initials: MW
authors.lastname: Hollmann
authors.forename: Markus
authors.initials: M
authors.lastname: Hollmann
authors.forename: Dirk T
authors.initials: DT
authors.lastname: Ubbink
authors.forename: Dirk
authors.initials: D
authors.lastname: Ubbink
authors.forename: Aeilko H
authors.initials: AH
authors.lastname: Zwinderman
authors.forename: Koos
authors.initials: K
authors.lastname: Zwinderman
authors.forename: Wouter J
authors.initials: WJ
authors.lastname: de Jonge
authors.forename: Wouter
authors.initials: W
authors.lastname: de Jonge
authors.forename: Susanne A
authors.initials: SA
authors.lastname: Snoek
authors.forename: Susanne
authors.initials: S
authors.lastname: Snoek
authors.forename: Karen
authors.initials: K
authors.lastname: Bolhuis
authors.forename: Esmerij  P M
authors.initials: E
authors.lastname: van der Zanden
authors.forename: Esmerij
authors.initials: E
authors.lastname: van der Zanden
authors.forename: Frans O
authors.initials: FO
authors.lastname: The
authors.forename: Frans
authors.initials: F
authors.lastname: The
authors.forename: Roel J
authors.initials: RJ
authors.lastname: Bennink
authors.forename: Roel
authors.initials: R
authors.lastname: Bennink
authors.forename: Guy E E
authors.initials: GE
authors.lastname: Boeckxstaens
authors.forename: Guy
authors.initials: G
authors.lastname: Boeckxstaens
mesh_terms: D000368:Aged; D003106:Colon / Q000502:physiology / Q000601:surgery*; D003107:Colorectal Surgery / Q000379:methods*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005746:Gastric Emptying / Q000502:physiology; D005769:Gastrointestinal Motility / Q000502:physiology; D041981:Gastrointestinal Tract / Q000000981:diagnostic imaging; D005772:Gastrointestinal Transit / Q000502:physiology*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D011877:Radionuclide Imaging; D020127:Recovery of Function / Q000502:physiology*; D016896:Treatment Outcome