title: Does an enhanced recovery programme add value to laparoscopic colorectal resections?
abstract: OBJECTIVE
  Enhanced recovery programmes (ERP) are now becoming integral to the management of patients undergoing colorectal resection. The benefits of ERP in patients undergoing open colorectal resections have been well recognized; however, the value of ERP in patients undergoing laparoscopic resections is still uncertain. This study was undertaken to assess the impact of ERP in our unit where nearly 90 % of elective colorectal resections are performed laparoscopically.
  
  
  METHODS
  A prospectively maintained database of all patients undergoing colorectal resections between Jan 2008 to December 2012 was analysed. The ERP programme was introduced in Aug 2010. The primary outcome measure was post-operative length of stay. Secondary outcome measures were post-operative morbidity and mortality.
  
  
  RESULTS
  A total of 506 patients underwent major colorectal resections in the study period (282 patients since introduction of ERP). There were no demographic differences between the pre-ERP and post-ERP groups of patients. The median length of stay prior to the introduction of ERP was 6 days (right-sided resections = 6, left-sided resections = 7.5 and rectal resections = 5.5). For post-ERP, the median length of stay was 5 days (right = 5.5, left = 5 and rectal = 4). Patients who had their laparoscopic procedure converted to open had a course similar to open resections. The morbidity and mortality was lesser in the ERP group but did not reach statistical significance.
  
  
  CONCLUSIONS
  The introduction of an ERP adds additional value in laparoscopic colorectal resections, with further reductions in morbidity and length of stay.
authors.affiliation: Department of Colorectal Surgery, Prince Charles Hospital, Merthyr Tydfil, CF47 9DT, UK. pavankumar_1124@yahoo.co.in.
authors.forename: P K
authors.initials: PK
authors.lastname: Dhruva Rao
authors.affiliation: Department of Colorectal Surgery, Prince Charles Hospital, Merthyr Tydfil, CF47 9DT, UK.
authors.forename: S
authors.initials: S
authors.lastname: Howells
authors.affiliation: Department of Colorectal Surgery, Prince Charles Hospital, Merthyr Tydfil, CF47 9DT, UK.|University of South Wales, Pontypridd, CF37 1DL, UK.
authors.forename: P N
authors.initials: PN
authors.lastname: Haray
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D003082:Colectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D003108:Colonic Diseases / Q000601:surgery; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D012002:Rectal Diseases / Q000601:surgery; D012189:Retrospective Studies; D055815:Young Adult
keywords: Bowel surgery; ERAS; Enhanced recovery programme; Laparoscopic colorectal resections