Optimal perioperative treatment for patients requiring segmental colectomy for colon cancer is laparoscopic resection embedded in a FT program. If open surgery is applied, it is preferentially done in FT care. This study was registered under NTR222 (www.trialregister.nl).

FT appears to be safe and shortens hospital stay after elective colorectal surgery. However, as the evidence is limited, a multicentre randomized trial seems justified.

BackgroundThis study was designed to systematically review the literature to assess which temporary abdominal closure (TAC) technique is associated with the highest delayed primary fascial closure (FC) rate. In some cases of abdominal trauma or infection, edema or packing precludes fascial closure after laparotomy. This “open abdomen” must then be temporarily closed. However, the FC rate varies between techniques.MethodsThe Cochrane Register of Controlled Trials, MEDLINE, and EMBASE databases were searched until December 2007. References were checked for additional studies. Search criteria included (synonyms of) “open abdomen,” “fascial closure,” “vacuum,” “reapproximation,” and “ventral hernia.” Open abdomen was defined as “the inability to close the abdominal fascia after laparotomy.” Two reviewers independently extracted data from original articles by using a predefined checklist.ResultsThe search identified 154 abstracts of which 96 were considered relevant. No comparative studies were identified. After reading them, 51 articles, including 57 case series were included. The techniques described were vacuum-assisted closure (VAC; 8 series), vacuum pack (15 series), artificial burr (4 series), Mesh/sheet (16 series), zipper (7 series), silo (3 series), skin closure (2 series), dynamic retention sutures (DRS), and loose packing (1 series each). The highest FC rates were seen in the artificial burr (90%), DRS (85%), and VAC (60%). The lowest mortality rates were seen in the artificial burr (17%), VAC (18%), and DRS (23%).ConclusionsThese results suggest that the artificial burr and the VAC are associated with the highest FC rates and the lowest mortality rates.

Background: To evaluate the feasibility of a fast-track (FT) program and it’s effect on postoperative recovery. Methods: All patients, scheduled for elective segmental colorectal resection were treated in a FT program (FT group). Data were compared to a control group operated for elective colorectal resections and treated in a traditional care program (TC group). Data from the FT group were collected prospectively, data from the TC group retrospectively. Outcome parameters included the number of successfully applied FT modalities, patient satisfaction, morbidity rate, re-operation rate, primary (PHS) and total hospital stay (THS), and readmission rate. Results: One-hundred and seven patients were included (55 FT group vs. 52 TC group). The groups were comparable for patient characteristics such as age and cr-POSSUM score (p = 0.22 and p = 0.40). An average of 7.4 of 13 predefined FT modalities were successfully achieved per patient. Patient satisfaction was comparable (p = 0.84). Seven versus 5 patients required a re-operation in the FT and TC groups, respectively (p = 0.52). Morbidity rate was comparable (n = 16 vs. 15, p = 0.83). Median PHS was 4.0 vs. 6.0 days and median THS was 4.0 vs. 6.5 days in the FT and TC groups (p < 0.01 and p < 0.03, respectively). Six vs. 3 patients were re-admitted in the FT and TC groups, respectively (p = 0.49). Conclusion: Implementation of all FT modalities was difficult since a rather low number of pre-defined FT modalities was effectively realized. Despite incomplete implementation, PHS and THS were shorter in the FT group without affecting patient satisfaction.

Evaluating only those fast track elements that were successfully achieved, enforced advancement of oral intake, early mobilization, laparoscopic surgery and female sex were independent determinants of early recovery.