Influence of fast-track rehabilitation on laparoscopic left sigmoid and rectal resection

Background: Laparoscopic colonic resection with traditional perioperative care has some short-term benefits postoperatively regarding functional recovery. Whether or not these benefits may additionally be improved when all patients are treated with multimodal fast-track rehabilitation programs is questionable. Patients and Methods: In a prospective nonrandomised observational study, patients undergoing laparoscopic resection of the sigmoid or upper rectum were treated perioperatively either traditionally or with fast-track rehabilitation. Essential parts of the fast-track program were patient education, thoracic peridural analgesia, forced mobilization and oral intake, and stress reduction. Endpoints were general and local complications as well as the forced vital capacity (FVC). Results: 116 consecutive patients were operated laparoscopically. 33 received traditional care and 83 fast-track rehabilitation. The time until oral intake was completed was shorter in the fast-track group (p < 0.01), resulting also in a shorter hospital stay (-4 days; p < 0.01). The FVC was postoperatively improved in the fast-track group compared to the traditional group (p < 0.01). With respect to general (18% traditional versus 8% fast-track) and local complications (12% traditional versus 13% fast-track), no significant differences were found between the groups. Conclusion: Perioperative fast-track rehabilitation programs improve the functional recovery after laparoscopic colonic surgery and further reduce hospital stay.