title: Outpatient colectomy within an enhanced recovery program.
abstract: BACKGROUND
  The application of a fast-track recovery program after surgery can decrease the physiological impact of surgery and reduce the duration of hospitalisation compared to conventional care. This program has permitted us to consider the performance of colectomy on an outpatient basis.
  
  
  METHODS
  After analyzing the recommendations for fast-track recovery, we developed and validated a specific protocol. Drawing on extensive experience in ambulatory surgery (inguinal hernia, cholecystectomy, adjustable gastric-banding), we formalized a protocol for outpatient colectomy. Patient selection criteria were the absence of serious or decompensated comorbidity, very good general condition, and full patient understanding of the procedure. Discharge was authorized if the patient met the exit criteria according to the Chung score. Postoperative surveillance was provided by regular home visits of a nurse trained in enhanced recovery, every afternoon until day 10.
  
  
  RESULTS
  Five patients underwent this management strategy (4 men and 1 woman, mean age 64 years, range: 59-69), for indications including cancer of the rectosigmoid junction (1 case), sigmoid diverticulitis (3 cases), and volvulus. The postoperative course was simple and uncomplicated except for two patients who had dysuria and an incisional hematoma, respectively.
  
  
  CONCLUSIONS
  To our knowledge, these are the first cases of colectomy performed strictly on an outpatient basis (i.e., stay<12h). We demonstrated the feasibility of outpatient colectomy when integrated into a protocol of enhanced recovery for selected patients provided that at-home monitoring was available.
authors: General surgery unit, visceral and endocrine, Clinic Backup, Ben-Gurion avenue, 69009 Lyon, France. Electronic address: gignoux@chirurgien-digestif.com.
authors: B
authors: B
authors: Gignoux
authors: General surgery unit, visceral and endocrine, Clinic Backup, Ben-Gurion avenue, 69009 Lyon, France.
authors: A
authors: A
authors: Pasquer
authors: General surgery unit, visceral and endocrine, Clinic Backup, Ben-Gurion avenue, 69009 Lyon, France.
authors: A
authors: A
authors: Vulliez
authors: General surgery unit, visceral and endocrine, Clinic Backup, Ben-Gurion avenue, 69009 Lyon, France.
authors: T
authors: T
authors: Lanz
mesh_terms: D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D003082:Colectomy / Q000379:methods*; D003108:Colonic Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D016896:Treatment Outcome
keywords: Colectomy; Colorectal surgery; ERAS; Enhanced recovery after surgery; Laparoscopy; Outpatient surgery