title: Enhanced recovery after surgery in gastric resections.
abstract: BACKGROUND
  Enhanced recovery after surgery is a modality of perioperative management with the purpose of improving results and providing a faster recovery of patients. This kind of protocol has been applied frequently in colorectal surgery, presenting less available experience and evidence in gastric surgery.
  
  
  METHODS
  According to the RICA guidelines published in 2015, a review of the bibliography and the consensus established in a multidisciplinary meeting in Zaragoza on the 9th of October 2015, we present a protocol that contains the basic procedures of fast-track for resective gastric surgery.
  
  
  RESULTS
  The measures to be applied are divided in a preoperative, perioperative and postoperative stage. This document provides recommendations concerning the appropriate information, limited fasting and administration of carbohydrate drinks 2hours before surgery, specialized anesthetic strategies, minimal invasive surgery, no routine use of drainages and tubes, mobilization and early oral tolerance during the immediate postoperative period, as well as criteria for discharge.
  
  
  CONCLUSIONS
  The application of a protocol of enhanced recovery after surgery in resective gastric surgery can improve and accelerate the functional recovery of our patients, requiring an appropriate multidisciplinary coordination, the evaluation of obtained results with the application of these measures and the investigation of controversial topics about which we currently have limited evidence.
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Valencia, Valencia, España. Electronic address: drbruna@comv.es.
authors.forename: Marcos
authors.initials: M
authors.lastname: Bruna Esteban
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Valencia, Valencia, España.
authors.forename: Peter
authors.initials: P
authors.lastname: Vorwald
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Valencia, Valencia, España.
authors.forename: Sonia
authors.initials: S
authors.lastname: Ortega Lucea
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Valencia, Valencia, España.
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Ramírez Rodríguez
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Valencia, Valencia, España.
mesh_terms: D002985:Clinical Protocols; D005260:Female; D005743:Gastrectomy / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D010348:Patient Care Team
keywords: Cirugía gástrica; Enhanced recovery after surgery; Fast-track; Gastric surgery; Recuperación intensificada; Rehabilitación multimodal