title: Short-term outcomes of laparoscopy combined with enhanced recovery pathway after ileocecal resection for Crohn's disease: a case-matched analysis.
abstract: BACKGROUND
  Laparoscopy combined with an enhanced recovery pathway (ERP) is widely considered to be the first-choice option for patients with colorectal cancer. However, no previous reports have focused on patients with Crohn's disease (CD) treated by laparoscopy and ERP.
  
  
  METHODS
  Twenty patients with CD underwent laparoscopic ileocecal resection with an ERP at two institutions. The ERP protocol included no bowel preparation nor fasting, no nasogastric tube, no abdominal drains, early removal of urinary catheter, early solid dietary intake and mobilization, opioid-sparing analgesia and restrictive fluid management. This group was compared with a matched historical control group of 70 CD patients who underwent laparoscopic ileocecal resection treated with conventional care.
  
  
  RESULTS
  Compliance with the ERP was high (≥80 %) for all items except no drain placement. A significantly earlier return of bowel function (time to first flatus and stool) was observed in the ERP group. Mean postoperative and total length of stay were significantly shorter in the ERP group. Postoperative complications were similar in both groups.
  
  
  CONCLUSIONS
  This is the first reported experience of laparoscopy with ERP in CD patients and suggests that optimized perioperative care combined with minimally invasive techniques may lead to further improvements in surgical outcomes for CD patients.
authors.affiliation: Department and Chair of General Surgery, Istituto Clinico Humanitas-IRCCS, University of Milan, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy. antonino.spinelli@humanitas.it
authors.forename: Antonino
authors.initials: A
authors.lastname: Spinelli
authors.forename: Piero
authors.initials: P
authors.lastname: Bazzi
authors.forename: Matteo
authors.initials: M
authors.lastname: Sacchi
authors.forename: Silvio
authors.initials: S
authors.lastname: Danese
authors.forename: Gionata
authors.initials: G
authors.lastname: Fiorino
authors.forename: Alberto
authors.initials: A
authors.lastname: Malesci
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Gentilini
authors.forename: Gilberto
authors.initials: G
authors.lastname: Poggioli
authors.forename: Marco
authors.initials: M
authors.lastname: Montorsi
mesh_terms: D000293:Adolescent; D000328:Adult; D002432:Cecum / Q000601:surgery*; D003424:Crohn Disease / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D020127:Recovery of Function; D016896:Treatment Outcome; D055815:Young Adult