[Multimodal rehabilitation in colorectal surgery. On resistance to change in surgery and the demands of society].

Perioperative management is one of the fields of surgery most hide bound by tradition and conventional attitudes are difficult to modify even in the face of strong scientific evidence. One of the advances that has most helped to improve the results of colorectal surgery is multimodal or fast-track rehabilitation, which aims to enhance recovery, reduce morbidity, and shorten the length of hospital stay. This modality is based on a multidisciplinary approach provided by surgeons, anesthesiologists and other staff and aims to decrease the response to physiopathological changes induced by surgical aggression. There is evidence to support the use of preoperative oral carbohydrate therapy and oral bowel preparation, the avoidance of intraoperative fluid excess, and the maintenance of normothermia on postoperative recovery. Other factors that can also reduce complications are epidural analgesia, avoidance of drainage and nasogastric decompression, early oral feeding, and minimally invasive surgery. There is strong evidence that the combined use of these and other measures enhances postsurgical recovery, although many of these measures are currently little used in daily practice.