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P366. Enhanced recovery program applied to laparoscopic ileocecal resection for Crohn's disease

A. Spinelli1, P. Bazzi1, M. Sacchi1, S. Danese2, G. Fiorino2, L. Gentilini3, G. Poggioli4, M. Montorsi1

1Istituto Clinico Humanitas – Università degli Studi di Milano, Dept. of Surgery, Rozzano Milano, Italy; 2Istituto Clinico Humanitas, IBD Unit, Rozzano Milano, Italy; 3University of Bologna, Bologna, Italy; 4Policlinico S. Orsola Malpigli-Università Di Bologna, Instituto di Clinica Chirurgica e Cardiochirurgia II Clinica Chirurgica e Terapia Chirurgica, Bologna, Italy

Background: Two major innovations have drastically modified colorectal surgery over the last 20 years: laparoscopy and the introduction of multimodal integrated perioperative programs (ERAS, Enhanced Recovery After Surgery, also known as Fast Track programs). ERAS applies evidence-based concepts to perioperative care of surgical patients: it aims to reduce surgical stress, allowing a faster and smoother postoperative recovery. A recent RCT proved that the combination of laparoscopy with ERAS represents the best option for colorectal cancer patients. There are surprisingly no data on CD patients treated by laparoscopy and ERAS program.

Methods: Twenty consecutive patients planned for ileocecal resection for uncomplicated CD at two IBD referral centers were prospectively enrolled. Patients underwent laparoscopic ileocecal resection (LIR) and were treated according to ERAS program (LIR+ERAS group): no preoperative bowel preparation nor fasting, no nasogastric tubes, no abdominal drains, early removal of urinary catheters, early feeding and mobilization, multimodal opioid-free analgesia and restrictive perioperative fluid management. Enrolled patients were compared with 70 patients treated by LIR and conventional care (CC) (LIR+CC group), matched for age, sex, disease presentation, BMI, ASA score, preoperative therapy.

Results: Results are presented in Table 1.

LIR = laparoscopic ileocecal resection; ERAS = enhanced recovery after surgery; CC = conventional care. * t-test; ° chi-squared-test.
Table 1.
 LIR + ERAS (n = 20)LIR + CC (n = 70)p
Time to first flatus (days – mean ± SD)1.7±0.72.8±1.50.002*
Time to first bowel movement (days – mean ± SD)3.0±0.93.6±1.10.03*
Postoperative length of stay (days – mean ± SD)5.3±1.66.8±3.10.04*
Total length of stay (days – mean ± SD)5.3±1.67.9±3.40.001*
Postoperative pain: VAS Score >3 on p.o. day 1 (n; %)8; 40%19; 27.1%n.s°
Postoperative pain: VAS Score >3 on p.o. day 22; 10%4; 5.7%n.s°
Major complication rate (bleeding, leakage, abdominal abscess)3; 15%7; 10%n.s°
Minor complication rate (ileus, intraluminal bleeding, wound infection)2; 10%10; 14.3%n.s°
Readmissions within 30 days from discharge0; 0%2; 2.8%n.s°

Conclusions: This is the first experience combining laparoscopic surgery with integrated multimodal ERAS protocols on CD patients. Our data showed a significantly faster return of normal bowel function and shorter hospital stay for the LIR+ERAS group. This suggests that optimized perioperative care combined with minimally invasive techniques may lead to further improvements in surgical outcomes for CD patients.