Faster Recovery of GastroIntestinal Transit After Laparoscopy and Fast-Track Care in Patients Undergoing Colonic Surgery
van Bree, Sjoerd Vlug, Malaika Bemelman, Willem Hollmann, Markus Ubbink, Dirk Zwinderman, Koos de Jonge, Wouter Snoek, Susanne Bolhuis, Karen van der Zanden, Esmerij The, Frans Bennink, Roel Boeckxstaens, Guy # ×
BACKGROUND & AIMS: Postoperative ileus is characterized by delayed gastrointestinal (GI) transit and is a major determinant of recovery after colorectal surgery. Both laparoscopic surgery and fast-track multimodal perioperative care have been reported to improve clinical recovery. However, objective measures supporting faster GI recovery are lacking. Therefore, GI transit was measured following open and laparoscopic colorectal surgery with or without fast-track care. METHODS: Patients (n=93) requiring elective colonic surgery were randomized to laparoscopic or conventional surgery with fast track multimodal management or standard care, resulting in four treatment arms. Gastric emptying and colonic transit were scintigraphically assessed from day 1 to 3 in 78 patients and compared to clinical parameters such as time to tolerance of solid food and/or bowel movement, and time until (ready for) discharge. RESULTS: 71 patients without mechanical bowel obstructions or surgical complications requiring intervention were available for analysis. No differences in gastric emptying 24 hours after surgery between the different groups were observed (P = 0.61). However, the median colonic transit of patients undergoing laparoscopic/fast-track care was significantly faster, compared to the laparoscopic/standard, open/fast-track, and open/standard care group. Multiple linear regression analysis showed that both laparoscopic surgery and fast-track care were significant independent predictive factors of improved colonic transit. Both were associated with significantly faster clinical recovery and shorter time until tolerance of solid food&first bowel movement. CONCLUSIONS: These data demonstrate that colonic transit recovers significantly faster after laparoscopic surgery and the fast-track program, providing objective data that laparoscopy and fast-track care lead to faster recovery of GI motility and concomitant enhanced clinical recovery.