Results of a colorectal enhanced recovery after surgery (ERAS) programme and a qualitative analysis of healthcare workers' perspectives.

BACKGROUND: Enhanced recovery after surgery (ERAS) is a structured programme using a multimodal, evidence-based approach to improve post-operative outcomes. Successful implementation of ERAS can be challenging. We aimed to evaluate our initial experience with colorectal ERAS and explore the perspectives of specialist doctors and nurses. METHODS: From 1 June 2017 to 31 December 2017, all patients who underwent elective colorectal resection and met the ERAS inclusion criteria at the Department of Colorectal Surgery, Singapore General Hospital, were included in the study. Short-term outcomes were compared between patients with >70% compliance to key ERAS components versus those with ≤70% compliance. Department staff were surveyed via questionnaire in July 2019. RESULTS: Three hundred and fifteen patients were included in study. >70% ERAS compliance rate was achieved in 84 patients (26.7%). A higher compliance rate resulted in a significantly shorter length of stay of 6 (IQR 5-8) days vs. 7 (IQR 6-9.5) days (p = 0.025) and lower readmission rate of 3.6% (n = 3) vs. 4.8% (n = 11) (p = 0.042), as well as a trend towards reduced complication rate of 15.4% (n = 13) vs. 22.0% (n = 51) and earlier return to gastrointestinal function. There was a 100% questionnaire response amongst all 12 colorectal surgeons and 5 colorectal resident nurse practitioners. CONCLUSION: Increased adherence to the components of ERAS results in better early outcomes and may have long-term benefits on survival. Effective communication and professional support for the ERAS multi-disciplinary team, as well as understanding healthcare workers' concerns and addressing long-standing practices, is essential for successful implementation of the programme.

Conventional laparoscopic versus single-incision laparoscopic right hemicolectomy: a case cohort comparison of short-term outcomes in 144 consecutive cases.

BACKGROUND: Single-incision laparoscopic surgery (SILS) is a recent development of minimally invasive surgery for colorectal disease. The literature comparing it against conventional laparoscopic colectomy remains limited. METHODS: A retrospective case-cohort study compared the benefits and outcomes of SILS right hemicolectomy (SRH) with those of conventional laparoscopic right hemicolectomy (LRH). The medical records of consecutive patients from a prospectively collected database were reviewed. Demographic data, operative details, recovery parameters, and details of resected specimens were obtained and analyzed in an intention-to-treat manner. RESULTS: From January 2006 to March 2011, 104 elective LRHs (72 %) and 40 elective SRHs (28 %) were performed. The demographics for these two groups were comparable in terms of gender, age, ethnicity, body mass index (BMI), comorbidities and American Society of Anesthesiology score. As the records showed, 62 % of the LRHs and 57 % of the SRHs were performed for malignancies (p = 0.536). Seven of the LRH cases (7 %) were converted to open procedure, whereas two of the SILS cases (5 %) were converted. Three SILS cases (7 %) were completed with additional laparoscopic ports. The two groups did not differ significantly in terms of wound length, mean operative time, lymph node clearance, or margins of resected specimen. The recovery parameters (pain score, hospital length of stay, and complications rate) also were equivalent between the two groups. CONCLUSION: As a feasible and safe procedure with early postoperative outcomes equivalent to those for LRH, SRH is a suitable alternative. The possible advantages of SILS over conventional laparoscopic surgery may be validated only with randomized controlled trials in the future.

Reversible recurrent laryngeal nerve palsy in acute thyroiditis.

First reported by Nager in 1927, unilateral vocal cord paralysis associated with thyroid disease suggests the malignant and irreversible nature of the thyroid lesion. This condition is rarely seen in benign thyroid diseases, and the function of the vocal cord does not usually return. We present a 54-year-old woman with a history of right hemithyroidectomy for benign thyroid nodule, who had an episode of subacute thyroiditis associated with unilateral vocal cord paralysis. The patient was treated with intravenous antibiotics and underwent a completion thyroidectomy. Post operation, her vocal cord function recovered successfully. Unilateral vocal cord paralysis can be seen in thyroiditis, and this can be reversed with steroids and antibiotics. If surgery is necessary, care must be taken to preserve the recurrent laryngeal nerve.