Multimodal approach in colorrectal surgery without mechanical bowel cleansing.

Area of Science:

• Surgical Innovation
• Perioperative Care Optimization
• Colorectal Surgery Outcomes

Background:

• Traditional perioperative management in colorectal surgery often involves prolonged fasting and extensive fluid administration.
• The need for evidence-based protocols to improve patient outcomes and reduce healthcare costs in colorectal surgery is critical.

Purpose of the Study:

• To evaluate the impact of the ACERTO protocol, a multimodal perioperative care strategy, on patients undergoing colorectal operations.
• To compare outcomes including morbidity, mortality, and length of hospital stay between patients managed with the ACERTO protocol versus conventional care.

Main Methods:

• A prospective study comparing two groups of colorectal surgery patients: a conventional group (n=25) and an ACERTO protocol group (n=28).
• The ACERTO protocol involved a multidisciplinary approach without mechanical bowel cleansing, contrasting with traditional methods.
• Key outcomes assessed included postoperative morbidity, mortality rates, anastomotic leak incidence, and length of hospital stay.

Main Results:

• The ACERTO protocol group experienced a significant reduction in length of hospital stay by 4.5 days (p=0.04).
• While overall morbidity and anastomotic leak rates were similar, the number of complications per patient was lower in the ACERTO group (p=0.01).
• Preoperative fasting and postoperative feeding durations were shortened, and intravenous fluid administration was reduced in the ACERTO group (p<0.05).

Conclusions:

• The ACERTO protocol is a safe and effective multimodal strategy for enhancing recovery in colorectal surgery.
• Implementation of the ACERTO protocol leads to reduced hospitalization duration and decreased severity of postoperative complications.
• This multidisciplinary approach represents a significant advancement in perioperative care for colorectal surgical patients.