title: Enhanced Recovery Pathway for Right and Left Colectomy: Comparison of Functional Recovery.
abstract: Enhanced recovery (ERAS) guidelines do not differentiate between left- and right-sided colectomies, but differences in recovery have been reported for the two procedure types. We aimed to compare compliance with the ERAS protocol and outcomes after right versus left colectomy.
  
  
  
  Between June 2011 and September 2014, all patients undergoing elective colonic resection were treated according to a standardized ERAS protocol and entered a prospective database. This retrospective analysis compared right and left colectomy regarding application of the ERAS pathway, bowel recovery, complications, and hospital stay.
  
  
  
  Eighty-five patients with right colectomy matched well with 138 left-sided resections for baseline demographics. Overall compliance with the ERAS protocol was 76 % for right versus 77 % for left colectomy patients (p = 0.492). First flatus occurred at postoperative day 2 in both groups (p = 0.057); first stool was observed after a median of 3 (right) and 2 days (left), respectively (p = 0.189). Twenty patients (24 %) needed postoperative nasogastric tube after right colectomy compared to 11 patients (8 %) after left colectomy (p = 0.002). Overall complication rates were 49 and 37 % for right and left colectomy, respectively (p = 0.071). Median postoperative length of stay was 6 days (IQR 4-9) after right and 5 days (IQR 4-7.5) after left colectomy (p = 0.020).
  
  
  
  Overall compliance with the protocol was equally high in both groups showing that ERAS protocol was applicable for right and left colectomy. Functional recovery however, tended to be slower after right colectomy, and postoperative ileus rate was significantly higher. More cautious early feeding after right colectomy should be considered.
authors.affiliation: Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
authors.forename: Anne
authors.initials: A
authors.lastname: Kummer
authors.affiliation: Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
authors.forename: Juliette
authors.initials: J
authors.lastname: Slieker
authors.affiliation: Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Grass
authors.affiliation: Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
authors.forename: Dieter
authors.initials: D
authors.lastname: Hahnloser
authors.affiliation: Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland. demartines@chuv.ch.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.affiliation: Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Hübner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D003672:Defecation; D004434:Early Ambulation; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D005414:Flatulence / Q000503:physiopathology; D019983:Guideline Adherence; D006801:Humans; D045823:Ileus / Q000209:etiology; D007441:Intubation, Gastrointestinal; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011184:Postoperative Period; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors