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World J Gastroenterol. Dec 14, 2013; 19(46): 8543-8551
Published online Dec 14, 2013. doi: 10.3748/wjg.v19.i46.8543
Early rehabilitation programs after laparoscopic colorectal surgery: Evidence and criticism
Duck-Woo Kim, Sung-Bum Kang, Soo-Young Lee, Heung-Kwon Oh, Myung-Hoon In
Duck-Woo Kim, Sung-Bum Kang, Soo-Young Lee, Heung-Kwon Oh, Myung-Hoon In, Department of Surgery, Seoul National University Bundang Hospital, Seongnam 463-707, South Korea
Author contributions: Kim DW and Kang SB designed research; Kim DW, Lee SY, Oh HK and In MH performed research; Kim DW, Kang SB, Oh KW and In MH analyzed data; Kim DW, Kang SB and Lee SY wrote the paper.
Correspondence to: Sung-Bum Kang, Associate Professor, Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam 463-707, South Korea. kangsb@snubh.org
Telephone: +82-31-7877093 Fax: +82-31-7874055
Received: September 25, 2013
Revised: November 1, 2013
Accepted: November 12, 2013
Published online: December 14, 2013
Processing time: 84 Days and 1.4 Hours
Abstract

During the past several decades, early rehabilitation programs for the care of patients with colorectal surgery have gained popularity. Several randomized controlled trials and meta-analyses have confirmed that the implementation of these evidence-based detailed perioperative care protocols is useful for early recovery of patients after colorectal resection. Patients cared for based on these protocols had a rapid recovery of bowel movement, shortened length of hospital stay, and fewer complications compared with traditional care programs. However, most of the previous evidence was obtained from studies of early rehabilitation programs adapted to open colonic resection. Currently, limited evidence exists on the effects of early rehabilitation after laparoscopic rectal resection, although this procedure seems to be associated with a higher morbidity than that reported with traditional care. In this article, we review previous studies and guidelines on early rehabilitation programs in patients undergoing rectal surgery. We investigated the status of early rehabilitation programs in rectal surgery and analyzed the limitations of these studies. We also summarized indications and detailed protocol components of current early rehabilitation programs after rectal surgery, focusing on laparoscopic resection.

Keywords: Colorectal cancer; Enhanced recovery after surgery; Early rehabilitation; Fast-track; Laparoscopy; Rectal

Core tip: Several randomized trials and meta-analyses have confirmed that the implementation of early rehabilitation programs for perioperative care is useful for recovery of patients after colorectal resection. However, most of the previous evidence is obtained from studies of early rehabilitation programs adapted to open colonic resection. Currently, early rehabilitation combined with laparoscopic rectal surgery can be a feasible alternative in some selected patients, but indications are not established. Current evidence fails to support the safety of early rehabilitation combined with laparoscopic rectal surgery compared to that reported for laparoscopic colon surgery.