W Schwenk1, W Raue, O Haase, T Junghans, J M Müller. 1. Universitätsklinik für Allgemein-, Viszeral-, Gefäss- und Thoraxchirurgie, Medizinische Fakultät der Humboldt-Universität zu Berlin. wolfgang.schwenk@charite.de
Abstract
OBJECT: The aim of multimodal perioperative treatment concepts is to lower the extent of general complications after elective colonic resection and "traditional" perioperative therapy and to allow hospital discharge only a few days following the operation. MATERIALS AND METHODS: In this prospective study, we examined a new perioperative treatment plan for accelerating postoperative recovery and evaluated the results. This so-called "fast-track" program employs combined thoracal peridural analgesia, forced mobilization, and rapid renourishment within the clinic. RESULTS: Sixty-four consecutive patients with benign or malignant disease of the large intestine aged an average of 66 years (range 54-71) were operated on. Thirty received conventional resection and 34 were operated on laparoscopically and treated perioperatively using the fast-track program. The hospital diet was given in all cases on the 1st postoperative day, and the first bowel movement occurred on the 2nd day (range 2-3). The patients could be released on the 4th postresection day (range 4-5). General and local postoperative complications were observed in five patients each (8%), including two cases of anastomotic insufficiency. CONCLUSION: In colonic surgery, the "fast-track" method accelerated convalescence, lowered the number of general complications, and reduced the duration of hospital stay. Therefore, evaluation of "fast-track" concepts is warranted in other types of elective abdominal surgery.
OBJECT: The aim of multimodal perioperative treatment concepts is to lower the extent of general complications after elective colonic resection and "traditional" perioperative therapy and to allow hospital discharge only a few days following the operation. MATERIALS AND METHODS: In this prospective study, we examined a new perioperative treatment plan for accelerating postoperative recovery and evaluated the results. This so-called "fast-track" program employs combined thoracal peridural analgesia, forced mobilization, and rapid renourishment within the clinic. RESULTS: Sixty-four consecutive patients with benign or malignant disease of the large intestine aged an average of 66 years (range 54-71) were operated on. Thirty received conventional resection and 34 were operated on laparoscopically and treated perioperatively using the fast-track program. The hospital diet was given in all cases on the 1st postoperative day, and the first bowel movement occurred on the 2nd day (range 2-3). The patients could be released on the 4th postresection day (range 4-5). General and local postoperative complications were observed in five patients each (8%), including two cases of anastomotic insufficiency. CONCLUSION: In colonic surgery, the "fast-track" method accelerated convalescence, lowered the number of general complications, and reduced the duration of hospital stay. Therefore, evaluation of "fast-track" concepts is warranted in other types of elective abdominal surgery.
Authors: F Marusch; A Koch; U Schmidt; R Zippel; M Lehmann; H D Czarnetzki; M Knoop; S Geissler; M Pross; I Gastinger; H Lippert Journal: Int J Colorectal Dis Date: 2001-11 Impact factor: 2.571
Authors: J Rose; C Schneider; H Scheidbach; C Yildirim; H P Bruch; J Konradt; E Bärlehner; F Köckerling Journal: Langenbecks Arch Surg Date: 2002-07-18 Impact factor: 3.445
Authors: F Marusch; A Koch; U Schmidt; R Zippel; S Geissler; M Pross; A Roessner; F Köckerling; I Gastinger; H Lippert Journal: Chirurg Date: 2002-02 Impact factor: 0.955
Authors: M Hensel; W Schwenk; A Bloch; W Raue; S Stracke; T Volk; C von Heymann; J M Müller; W J Kox; C Spies Journal: Anaesthesist Date: 2006-01 Impact factor: 1.041
Authors: W Schwenk; N Günther; P Wendling; M Schmid; W Probst; K Kipfmüller; B Rumstadt; M K Walz; R Engemann; T Junghans Journal: Int J Colorectal Dis Date: 2007-08-18 Impact factor: 2.571
Authors: B Rumstadt; N Guenther; P Wendling; R Engemann; C T Germer; M Schmid; K Kipfmueller; M K Walz; W Schwenk Journal: World J Surg Date: 2009-08 Impact factor: 3.352
Authors: O Gralla; F Haas; N Knoll; D Hadzidiakos; M Tullmann; A Romer; S Deger; V Ebeling; M Lein; A Wille; B Rehberg; S A Loening; J Roigas Journal: World J Urol Date: 2006-12-15 Impact factor: 4.226