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THE ENHANCED RECOVERY AFTER SURGERY PROTOCOL FOR RIGHT COLECTOMY Daishi Naoi*, Hisanaga Horie, Koji Koinuma, Yoshiyuki Inoue, Homare Ito, Yosihiko Kono, Katsusuke Mori, Makiko Tahara, Ai Sadatomo, Yasunaru Sakuma, Yoshinori Hosoya, Joji Kitayama, Alan K. Lefor, Naohiro Sata Surgery, Jichi Medical University, Tochigiken Shimotsukesi, Japan Objective and Background: The Enhanced Recovery After Surgery (ERAS）protocol was introduced in 2005. In Japan, some institutions adopted this protocol, but it is not universal. We adopted some ERAS items for patients undergoing elective right colectomy starting in June 2014. Methods: Data for 384 patients who underwent elective right colectomy from January 2010 to October 2017 were retrospectively reviewed. Patients were divided into two groups: ERAS and conventional care, and then categorized by laparoscopic resection or laparotomy. According to the ERAS protocol, there is no preoperative mechanical bowel preparation, the nasogastric tube is removed at the end of surgery, and oral intake starts as soon as possible postoperatively. Results: There were 182 (laparotomy:79, laparoscopic:103) patients in the ERAS group and 202 (laparotomy:118, laparoscopic:84) in the conventional group. In patients undergoing laparoscopic resections, there are no significant differences in operative factors (blood loss, operative time) or postoperative complications between the ERAS group and the conventional group. In patients undergoing laparotomy, the incidence of postoperative paralytic ileus in the ERAS group (2/79, 2.5%) was significantly lower than the conventional group (13/105, 11%) (P=0.03). However, the incidence of Surgical Site Infection (SSI) was significantly higher in the ERAS group (ERAS: 10/79, 12.7%, conventional: 3/118, 2.5%, p=0.0073). All SSIs were of the superficial incisional type. Conclusions: Outcomes for patients treated with the ERAS protocol are similar to conventional care for patients undergoing elective laparoscopic right colectomy. In patients undergoing laparotomy, the ERAS protocol is associated with a lower rate of post-operative paralytic ileus, but a higher incidence of SSI.
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