Seventy-two hour laparoscopic colectomy without an enhanced recoveryprogramme;150 consecutive cases in a DGH: P145

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Aim:Seventy-two hour colectomy is reported in thepresence of an enhanced recoveryprogramme (ERAS). ERAS however is expensive and labour intensive. We have assessed safety and feasibility of 72 hour laparoscopic colectomy without ERASMethod:Prospectively collected data was reviewed on 150 consecutive laparoscopic resections, undertaken but one operator between June 2006 and May 2010, without ERAS. No patient received an epidural. All were nursed in a level one ward with one nurse:four patients. Post-operative care was consultant driven. Diet was introduced the day of surgery. Catheters, drains and intravenous fluids were removed day 1 where appropriate. Patients were assessed for ASA, age, BMI, extraction site length, mortality and 30 day readmission.Results:With a mean age of 58, mean ASA of 2 and BMI of 29, 141 cases were completely laparoscopically. The mean wound length was 5.8 cm (4.3-8.4 cm). The mean and median length of stay was 3 days (2-18). Those patients staying over 4 days (n = 15) had either an ileostomy (n = 11), respiratory complications (n = 1), clostridium difficile (n = 2) or a small bowel obstruction requiring laparotomy (n = 1). There was 130 day readmission, the only anastomotic leak, representing day 12.Conclusion:Seventy-two hour laparoscopic colectomy is feasible in most and safe without ERAS.

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