Enhanced recovery programmes and colorectal surgery: does the laparoscope confer additional advantages?

Area of Science:

• Surgical innovation and patient recovery protocols.
• Comparative effectiveness of surgical techniques.

Background:

• Enhanced recovery after surgery (ERAS) protocols are designed to minimize postoperative length of stay (LOS).
• Laparoscopic surgery also aims to reduce LOS.
• The added benefit of combining laparoscopic surgery with ERAS protocols is not well-established.

Purpose of the Study:

• To evaluate whether laparoscopic surgery offers additional benefits when implemented within Enhanced Recovery After Surgery (ERAS) protocols.
• To compare outcomes of ERAS alone versus ERAS combined with laparoscopic surgery.

Main Methods:

• A comprehensive literature review was conducted from January 1966 to June 2008.
• Included studies were randomized trials and case series examining laparoscopic surgery within ERAS protocols.
• Outcomes assessed included LOS, readmissions, return of gut function, quality of life, and treatment costs.

Main Results:

• Four publications from three randomized trials and seven case series were identified.
• Two randomized trials found no significant difference in LOS or readmission rates between ERAS alone and ERAS with laparoscopic surgery.
• One trial reported a significantly shorter LOS and lower readmission rate with the combined approach.

Conclusions:

• The current limited evidence suggests that incorporating laparoscopic surgery into ERAS protocols may not yield further benefits.
• Additional high-quality research is necessary to draw definitive conclusions on the combined approach's efficacy.