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Enhanced recovery after colorectal surgery

Rocco Ricciardi, MD, MPH
Graham MacKay, MBChB, FRCS, FFST, MD
Girish P Joshi, MB, BS, MD, FFARCSI
Section Editor
Martin Weiser, MD
Deputy Editor
Wenliang Chen, MD, PhD


Enhanced recovery programs are evidence-based protocols designed to standardize medical care, improve outcomes, and lower health care costs. These protocols include evidence-based techniques to minimize surgical trauma and postoperative pain, reduce complications, improve outcomes, and decrease hospital length of stay, while expediting recovery following elective procedures.

Multimodal enhanced recovery after surgery (ERAS) is an integrated, multidisciplinary approach that requires participation and commitment from the patient, surgeons, anesthesiologists, pain specialists, nursing staff, physical and occupational therapists, social services, and hospital administration [1,2]. Initially, ERAS protocols converted many operations performed as inpatient to outpatient "day surgery" procedures. As experience developed with these protocols, principles of enhanced recovery were applied to increasingly complex procedures to reduce hospital length of stay and expedite return to baseline health and functional status [2,3].

ERAS protocols have been developed for colorectal surgery patients to reduce physiological stress and postoperative organ dysfunction through optimization of perioperative care and recovery [1,2,4]. Typically, such protocols include perioperative opioid-sparing analgesia, a laparoscopic approach for the colorectal resection, avoidance of nasogastric tubes and peritoneal drains, aggressive management of postoperative nausea and vomiting, and early oral feedings and ambulation (table 1) [5].

This topic will discuss preoperative, intraoperative, and postoperative strategies used in ERAS protocols developed for colorectal surgery. Other aspects of colorectal surgery are reviewed separately. (See "Overview of colon resection" and "Rectal cancer: Surgical principles" and "Rectal cancer: Surgical techniques".)


The goals of enhanced recovery after surgery (ERAS) protocols include attenuating the surgical stress response and reducing end organ dysfunction through integrated preoperative, intraoperative, and postoperative pathways. Discharge criteria with ERAS are similar to those of traditional care, but patients receiving ERAS care meet these discharge criteria sooner [1,2].

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Literature review current through: Nov 2017. | This topic last updated: Oct 30, 2017.
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