Fast track surgery particularly in case of patients undergoing colonic resection.

During the past several years numerous articles were published concerning the novel perioperative management method, the socalled ”fast track surgery”. The above-mentioned terminology was first used in case of colon surgery by Prof. Henrik Kehlet from the Department of Gastroenterological Surgery, Hvidovre Hospital in Copenhagen (currently section of Pathophysiological Surgery in Rigshospitalet). The following terminology is also used concerning the issue: Enhanced Recovery After Surgery (ERAS), multimodal rehabilitation, or Pathway of Controlled Rehabilitation with Early Ambulation and Diet (CREAD). The so-called “fast track’’ parameters can be allocated to three groups: preoperative, perioperative and postoperative. The former consists of an oral and written consent for perioperative management, a carbohydrate drink two hours before the procedure, administration of synbiotics, resignation from mechanical bowel preparation and premedication, as well as the limitation of intravenous fluids. Intraoperative factors include oxygenation, hypothermia prevention, high thoracic epidural anesthesia, minimally invasive surgery, resignation from the use of a nasogastric tube and abdominal drains. The latter group consists of rehabilitation and nutrition on the day of the operation, avoidance of opioids, the use of laxatives, early urinary bladder catheter removal, resignation from intravenous fluids and gum chewing. Management consists in the following: 1) better understanding of the pathophysiology of the injuryreduction of the number of postoperative complications, 2) management according to Evidence Based Medicine guidelineselimination of factors negatively influencing the patients quality of life, 3) shorter hospitalization which leads towards lower costs. In 1997, prof. Kehltet published the pathophysiological assumptions of the proposed strategy (1). However, two years earlier Bardram et al. (2) described nine elderly patients subject to laparoscopic resection of the colon. Most were discharged from the hospital two days after the procedure. In 1999, the founder of fast track surgery published an article concerning a twoday hospitalization after open sigmoidectomy (3). Literature data presented review articles containing actual data concerning fast track surgery (4, 5). one of the most recent publications concerning fast track parameters was elaborated by Counihan and Favuzza (6). one must not forget about the ERAS group, which was created by 5 university centers from Denmark, Norway, Sweden, Scotland, and Holland. The consensus review was published in 2005 (7) and 2010 (8). There also exist individual studies present in the Polish literature (9, 10). The study presented the main factors of “fast track surgery’’ based on recent literature data, according to Evidence Based Medicine. Novel investigations were selected from each field published after 2000. Data was collected from the Pub Med database and analysis of the British Journal of Surgery articles published between 2008 and 2010. Meta-analyses with the highest reliability predominated.