[Multimodal rehabilitation in colorectal surgery. On resistance to change in surgery and the demands of society]. / Rehabilitación mutimodal en cirugía colorrectal. Sobre la resistencia al cambio en cirugía y las demandas de la sociedad.

Perioperative management is one of the fields of surgery most hide bound by tradition and conventional attitudes are difficult to modify even in the face of strong scientific evidence. One of the advances that has most helped to improve the results of colorectal surgery is multimodal or fast-track rehabilitation, which aims to enhance recovery, reduce morbidity, and shorten the length of hospital stay. This modality is based on a multidisciplinary approach provided by surgeons, anesthesiologists and other staff and aims to decrease the response to physiopathological changes induced by surgical aggression. There is evidence to support the use of preoperative oral carbohydrate therapy and oral bowel preparation, the avoidance of intraoperative fluid excess, and the maintenance of normothermia on postoperative recovery. Other factors that can also reduce complications are epidural analgesia, avoidance of drainage and nasogastric decompression, early oral feeding, and minimally invasive surgery. There is strong evidence that the combined use of these and other measures enhances postsurgical recovery, although many of these measures are currently little used in daily practice.

Rehabilitación mutimodal en cirugía colorrectal. Sobre la resistencia al cambio en cirugía y las demandas de la sociedad / Multimodal rehabilitation in colorectal surgery. On resistance to changein surgery and the demands of society

El manejo perioperatorio es uno de los campos de la cirugía más sujetos a la tradición, y es difícil modificar actitudes clásicas incluso con la evidencia científica. Uno de los avances que más ha contribuido a mejorar el resultado tras cirugía colorrectal es la rehabilitación multimodal o fast-track, programa que pretende acelerar la recuperación, reduciendo la morbilidad y acortando las estancias. Se basa en la actuación conjunta de cirujanos, anestesistas y personal a cargo del paciente con el objetivo de disminuir la respuesta a las alteraciones fisiopatológicas inducidas por la agresión quirúrgica. Aspectos como la ingesta preoperatoria de carbohidratos, evitar la preparación de colon, reducir la fluidoterapia o mantener la normotermia son de gran importancia. Del mismo modo, la analgesia epidural, eliminación de sondas y drenajes, alimentación precoz o una cirugía menos invasiva pueden mejorar el íleo postoperatorio y otras complicaciones. Existe importante evidencia de que el uso conjunto de estas y otras medidas contribuye a una mejor recuperación posquirúrgica, aunque se sigue utilizándolas muy poco en la práctica (AU)

Perioperative management is one of the fields of surgery most hidebound by tradition and conventional attitudes are difficult to modify even in the face of strong scientific evidence. One of the advances that has most helped to improve the results of colorectal surgery is multimodal or fast-track rehabilitation, which aims to enhance recovery, reduce morbidity, and shorten the length of hospital stay. This modality is based on a multidisciplinary approach provided by surgeons, anesthesiologists and other staff and aims to decrease the response to physiopathological changes induced by surgical aggression. There is evidence to support the use of preoperative oral carbohydrate therapy and oral bowel preparation, the avoidance of intraoperative fluid excess, and the maintenance of normothermia on postoperative recovery. Other factors that can also reduce complications are epidural analgesia, avoidance of drainage and nasogastric decompression, early oral feeding, and minimally invasive surgery. There is strong evidence that the combined use of these and other measures enhances postsurgical recovery, although many of these measures are currently little used in daily practice (AU)