Editorial
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2019; 11(2): 41-52
Published online Feb 27, 2019. doi: 10.4240/wjgs.v11.i2.41
Enhanced recovery after surgery in emergency colorectal surgery: Review of literature and current practices
Varut Lohsiriwat, Romyen Jitmungngan
Varut Lohsiriwat, Romyen Jitmungngan, Division of Colon and Rectal Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Author contributions: Lohsiriwat V outlined the content, wrote and critically reviewed the manuscript; Jitmungngan R reviewed the literature and wrote the manuscript.
Conflict-of-interest statement: The authors declared that we had no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Varut Lohsiriwat, MD, PhD, Associate Professor, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang-Lung Road, Bangkok 10700, Thailand. bolloon@hotmail.com
Telephone: +662-419-8005 Fax: +662-412-1370
Received: February 6, 2019
Peer-review started: February 11, 2019
First decision: February 19, 2019
Revised: February 20, 2019
Accepted: February 21, 2019
Article in press: February 22, 2019
Published online: February 27, 2019
Processing time: 22 Days and 23.5 Hours
Abstract

Enhanced recovery after surgery (ERAS), a multidisciplinary program designed to minimize stress response to surgery and promote the recovery of organ function, has become a standard of perioperative care for elective colorectal surgery. In an elective setting, ERAS program has consistently been shown to decrease postoperative complication, reduce length of hospital stay, shorten convalescence, and lower healthcare cost. Recently, there is emerging evidence that ERAS program can be safely and effectively applied to patients with emergency colorectal conditions such as acute colonic obstruction and intraabdominal infection. This review comprehensively covers the concept and application of ERAS program for emergency colorectal surgery. The outcomes of ERAS program for this emergency surgery are summarized as follows: (1) The ERAS program was associated with a lower rate of overall complication and shorter length of hospital stay – without increased risks of readmission, reoperation and death after emergency colorectal surgery; and (2) Compliance with an ERAS program in emergency setting appeared to be lower than that in an elective basis. Moreover, scientific evidence of each ERAS item used in emergency colorectal operation is shown. Perspectives of ERAS pathway in emergency colorectal surgery are addressed. Finally, evidence-based ERAS protocol for emergency colorectal surgery is presented.

Keywords: Enhanced recovery after surgery; Emergency; Colon; Rectum; Surgery; Intraabdominal infection; Colonic obstruction; Diverticulitis; Review; Guideline

Core tip: This review comprehensively covers the concept and application of enhanced recovery after surgery (ERAS) program for emergency colorectal surgery. It was evident that ERAS program was associated with a lower rate of overall complication and shorter hospitalization – without increased risks of readmission, reoperation and death after emergency colorectal surgery. However, compliance with an ERAS program in emergency setting appeared to be lower than that in an elective basis. Scientific evidence of each ERAS item and perspectives of ERAS pathway in emergency colorectal surgery are addressed. Evidence-based ERAS protocol in this emergency setting is presented at the end of article.