Fast-track multimodal rehabilitation program improves outcome after laparoscopic sigmoidectomy -: A controlled prospective evaluation

Background: Laparoscopic colorectal resection improves patient outcome by reducing pain, postoperative pulmonary dysfunction, gastrointestinal paralysis.. and fatigue. A multimodal rehabilitation program ("fast-track") with epidural analgesia, early oral feeding, and enforced mobilization may further improve the excellent results of laparoscopic colorectal resection, enabling early ambulation of these patients. Methods: Fifty two consecutive patients underwent laparoscopic sigmoidectomy with standardized regular perioperative treatment (standard) or multimodal rehabilitation program ("fast-track"). Outcome measures included pulmonary function.. duration of postoperative ileus, pain perception, fatigue, morbidity, and mortality. Results: Twenty nine standard-care patients (19 men and 10 women) and 23 fast-track patients (15 men and eight women) were evaluated. Demographic and operative data were similar for the two groups. On the 1st postoperative day, pulmonary function was improved (p=0.01) in fast-track patients. Oral feeding was achieved earlier (p<0.01) and defecation occurred earlier (p<0.01) in the fast-track group. Visual analogue scale scores for pain were similar for the two groups (p>0.05): but fatigue was increased in the standard-care group on the 1st (p=0.06) and 2nd (p<0.05) postoperative days. Morbidity was not different for the two groups. Fast-track patients were discharged on day 4 (range. 3-6) and standard-care patients on day 7 (range, 4-1) (p<0.001). Conclusion: Multimodal rehabiliation can improve further on the excellent results of laparoscopic sigmoidectomy and decrease the postoperative hospital stay.