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Tebala et al. Mini-invasive Surg 2018;2:32 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2018.37

Review Open Access

Enhanced recovery after rectal surgery: what we have
learned so far

Giovanni D. Tebala, Ayeshah Gordon-Dixon, Mohammad Imtiaz, Ashish Shrestha, Mohamed Toeima

Colorectal and Emergency Surgery Unit, East Kent Hospitals University NHS Foundation Trust, William Harvey Hospital,
Ashford, Kent TN24 0LZ, UK.

Correspondence to: Giovanni D. Tebala, Colorectal and Emergency Surgery Unit, East Kent Hospitals University NHS
Foundation Trust, William Harvey Hospital, Kennington Rd, Willesborough, Ashford, Kent TN24 0LZ, UK.
E-mail: giovanni.tebala@nhs.net

How to cite this article: Tebala GD, Gordon-Dixon A, Imtiaz M, Shrestha A, Toeima M. Enhanced recovery after rectal surgery:
what we have learned so far. Mini-invasive Surg 2018;2:32. http://dx.doi.org/10.20517/2574-1225.2018.37

Received: 8 Jun 2018 First Decision: 27 Aug 2018 Revised: 31 Aug 2018 Accepted: 3 Sep 2018 Published: 28 Sep 2018

Science Editor: Gordon N. Buchanan Copy Editor: Cai-Hong Wang Production Editor: Zhong-Yu Guo

Abstract
Enhanced recovery after surgery (ERAS) protocols are gradually becoming the gold standard in the perioperative
management of rectal patients. It is a multimodal and multidisciplinary approach that has the great merit to involve
and empower the patient and bring him or her back to the centre of the strategy of care. If applied correctly, ERAS
can improve the postoperative recovery, reduce the rate of complications and reduce the postoperative length of
stay, in patients who had extensive pelvic dissection. The factors within ERAS and their application do not represent
rigid schematizations but fluid concepts that may undergo substantial changes as soon as new evidence becomes
available. The ERAS principles must be adapted to the specific environment and each team is expected to set up their
own programme and quality control criteria. In this comprehensive review, the latest evidence and trend on enhanced
recovery after rectal surgery have been critically appraised and presented.

Keywords: Laparoscopic surgery, rectal surgery, enhanced recovery after surgery

INTRODUCTION
The enhanced recovery after surgery (ERAS) programmes have been introduced in the 90s to improve the
[1,2]
outcome of patients undergoing major surgery . The concept at the basis of ERAS is to apply the best
and most recent evidences of the literature to set up standardized perioperative protocols to improve the
[3-5]
postoperative recovery and, only as an obvious consequence, to reduce the length of hospital stay (LOS) .
Unfortunately, the name initially used for these new protocols - “Fast Track” - sounded like a suggestion

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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