Reference Type: Journal Article
Record Number: 21
Author: Andersen, J.; Kehlet, H.
Year: 2005
Title: Fast track open ileo-colic resections for Crohn´s disease
Journal: Colorectal Disease
Volume: 7
Pages: 394-397
Abstract: Objective Introduction of multimodal rehabilitation
programmes after open colonic surgery for noninflammatory
bowel disease has reduced hospital stay to about
2­3 days, but no data are available from open ileo-colic
surgery for Crohn’s disease with multimodal rehabilitation
regimens. Therefore, the aim of study was to assess
outcome after ileo-colic resections for Crohn’s disease
with multimodal rehabilitation.
Materials and methods Thirty-two consecutive ileocolic
resections for Crohn’s disease in 29 patients
received epidural analgesia and enforced postoperative
oral nutrition and mobilization with a scheduled stay of
2 days.
Results Median time to defaecation was 2.5 days and
postoperative hospital stay was 3 days. During a 30-day
postoperative follow-up there was two re-admissions,
one for mechanical bowel obstruction (9 days) and one
because of fever and vomiting (6 days). Except for one
wound abscess, one cystitis and one pneumonia, no other
complications occurred.
Conclusion Fast-track multimodal rehabilitation in open
ileo-colic resections for Crohn’s disease reduces hospital
stay and with low morbidity and readmission rate.
Keywords Fast track surgery, Crohn’s disease, ileocolic
resection


Reference Type: Journal Article
Record Number: 18
Author: Basse, L.; Raskov, H.H.; Jakobsen, D.H.; Sonne, E.; Billesbolle, P.; Hendel, H.W.; Rosenberg, J.; Kehlet, H.
Year: 2002
Title: Accelerated postoperative recovery programme after colonic resection imporves physical performance, pulmonary function and bidy composition
Journal: Bristish Journal of Surgery
Volume: 89
Pages: 446-453


Reference Type: Journal Article
Record Number: 11
Author: Böhm, B.; Hasse, O.; Hofmann, H.; Heine, T.; Junghans, T.; Müller, J.M.
Year: 2000
Title: Verträglichkeit eines frühen oralen Kostaufbaus nach Operationen am unteren Gastrointestianltrakt
Journal: Chirurg
Volume: 71
Pages: 955-962


Reference Type: Conference Proceedings
Record Number: 27
Author: Bruch, H.P.; Schwandner, O.
Year of Conference: 2005
Title: Laparoskopische Chirurgie der Divertikulitis: Bewertung als Standard?
Ergebnisse der GAST Study Group
Conference Name: 122. Kongress der Deutschen Gesellschaft für Chirurgie
Conference Location: München
Publisher: Deutsche Gesellschaft für Chirurgie
URL: http://www.egms.de/en/meetings/dgch2005/05dgch336.shtml


Reference Type: Journal Article
Record Number: 1
Author: Cuming, Ric
Year: 2002
Title: Reducing length of stay with early oral intake
Journal: American Journal of Obstertrics and Gynecology
URL: http://www.findarticles.com/p/articles/mi_m0FSL/is_6_76/ai_95681608


Reference Type: Journal Article
Record Number: 12
Author: Decker-Baumann, C.
Year: 2000
Title: Diätische Konsequenz nach Gastrektomie
Journal: Chirurgische Gastroenterologie
Volume: 16, Supp. S2
Pages: 51-54
Abstract: After gastrectomy, changes of nutritional behavior (more than 6 servings per day, intensive chewing) are the most important measures to reduce postprandial complaints and to prevent postoperative malnutrition. The patients are allowed to return to a normal healthy diet, but in order to meet the nutrient requirements a careful dietary counselling is required. However, nutritional intervention is necessary in case of dumping syndrome, lactose intolerance and steatorrhea. Continuous inspections of body weight, dietary habits, supply with iron, vitamin D, folic acid, calcium and magnesium are mandatory to prevent deficiencies.


Reference Type: Journal Article
Record Number: 16
Author: Delaney, C.P.; Fazio, V.W.; Senagore, A.J.; Robinson, B.; Halversion, A.L.; Remzi, F.H.
Year: 2001
Title: `Fast track' postoperative management protocol for patients
with high co-morbidity undergoing complex abdominal and
pelvic colorectal surgery
Journal: British Journal of Surgery
Volume: 88
Pages: 1533-1538
Abstract: Background: A combination of factors has emphasized the need to
surgery. Multimodal care plans may shorten hospital stay, but
readmission rates and are generally reserved for straightforward, non-
resections. This study evaluated a `fast track' protocol in patients undergoing
surgery.
Methods: Sixty consecutive patients (median age 44´5 (range 13±70) years)
over a 6-week period on one colorectal service. Nasogastric tubes and
used. Patients participated in a protocol of early diet and early ambulation,
meeting de®ned criteria.
Results: Fifty-eight patients (97 per cent) were deemed suitable for the
of surgery and stayed for a mean(s.d.) of 4´3(1´6) days after operation.
group (DRG) 148 (colorectal resection with co-morbidity; n = 40) stayed
longer than those in DRG 149 (without co-morbidity; n = 18) who
Three patients (5 per cent) required a nasogastric tube for vomiting.
directly attributable to `fast track' failure, although four patients (7
30 days of operation for other reasons. Eight poorly compliant
(P = 0´02 versus compliant patients). `Fast track' patients had a shorter
receiving traditional care on other colorectal services during the
DRG 148, DRG 149 and for all patients) (P < 0´0001).
Conclusion: The `fast track' protocol allows patients with high levels
complex colorectal and reoperative pelvic surgery to bene®t from a
from hospital. The approach is safe and has low readmission rates.


Reference Type: Journal Article
Record Number: 14
Author: Delaney, C.P.; Zutshi, M.; Senagore, A.J.; Remzi, F.H.; Fazio, V.W.
Year: 2002
Title: Quality of life and level of pain in a randomized controlled trial between accelerated and traditional care pathways after major colorectal surgery
Journal: British Journal of Surgery
Volume: 89
Issue: 1
Pages: 6
Abstract: Aims: Fast track postoperative protocols can yield a 4.3-day (d) stay after intestinal surgery, compared to 7 10 d with traditional (TRAD) approaches. Patient satisfaction, quality of life and pain are poorly understood after abdominal surgery, and have not been compared after fast track and traditional care.

Methods: Sixty-four intestinal resection cases were randomly allocated to CREAD (controlled rehabilitation with early ambulation and diet) or TRAD. CREAD cases received: no NG tubes; ambulation and liquids on d 1; soft diet, oral analgesia on d 2. TRAD patients had: NG tubes; liquids, oral analgesia and diet after bowel function; ambulated on d 2. Postoperative endpoints at discharge, d 10 and d 30 used the Short Form-36 quality of life form, Cleveland clinic global quality of life scale (CGQL) and the McGill pain score.

Results: Length of stay including readmissions was 5.4 d in CREAD and 7.1 d in TRAD patients (P = 0.02). Changes in the mental component of the SF36 (reduced from 51 to 42, P < 0.01), and McGill score (increased from 3.9 to 7.6, P < 0.05) in CREAD patients at discharge, were resolved at d 10 and d 30, and are attributed to the shorter stay of CREAD patients. There were no differences in any other variable at any time.

Conclusions: Patients using the CREAD had a shorter postoperative stay, without altered quality of life or pain scores on d 10 and d 30 after surgery, when compared to patients managed by the TRAD approach. It should be considered as a primary care pathway for patients undergoing intestinal resection.


Reference Type: Journal Article
Record Number: 30
Author: Disbrow, Elizabeth A.; bennett, Henry, L.; Owings, John T.
Year: 1993
Title: Effect of preoperative suggestion in postoperative gastrointestinal motility
Journal: The Western Journal of medicine
Volume: 158
Issue: 5
Pages: 488-492


Reference Type: Journal Article
Record Number: 17
Author: Han-Geurts, I.J.M.; Jeekel, J.; Tilanus, H.W.; Brouwer, K.J.
Year: 2001
Title: Randomized clinical trial of patient-controlled versus fixed regimen feeding after elective abdominal surgery
Journal: Bristish Journal of Surgery
Volume: 88
Pages: 1578-1582


Reference Type: Journal Article
Record Number: 29
Author: Holter, O.
Year: 1993
Title: Postoperative enteral nutrition
Journal: Tidsskrift for den Norske laegeforening
Volume: 113
Issue: 4
Pages: 470-471
Abstract: The need for postoperative nutrition is often discussed, but no consensus has been reached regarding the assessment of this need. The common opinion is that patients who are unable to feed themselves by 5-7 days after the operation need nutritional support. This is commonly given parenterally via a central venous catheter. This method may lead to sepsis. Owing to the serious complications, alternatives have been searched for. Methods for enteral ways of support and suitable preparations have been evaluated. We have tried one of these methods together with one of the many preparations. Peptison has been administered continuously through a peroperatively placed jejunal catheter. This technique and its possible advantages are described. By this method patients can be given sufficient nutritional support with no or only few complications. We consider this method to be a good alternative to parenteral infusion.


Reference Type: Journal Article
Record Number: 19
Author: Kehlet, H.; Mogensen, T.
Year: British Journal of Surgery
Title: Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation programme
Journal: Bristish Journal of Surgery
Volume: 86
Issue: 227-230


Reference Type: Journal Article
Record Number: 9
Author: Krumwiede, K.H.
Year: 2004
Title: Ernährung nach Magenoperation
Journal: Ernährung und Medizin
Volume: 19
Issue: 3
Pages: 136-140
Abstract: Complete or partial removal of the stomach results in considerable anatomical and physiological changes which lead to more or less pronounced dietary problems. Nutritional counselling is essential to avoid the major postoperative problems. The selection of appropriate foodstuffs as well as the beverages and the way of their intake should be discussed. Preprandial exercise in order to stimulate the appetite is just as important as postprandial resting to avoid the dumping syndrome. Food intake should be divided into six to ten small portions per day. Substitution of vitamin B 12, the fat-soluble vitamins, calcium, and iron may be necessary.


Reference Type: Journal Article
Record Number: 20
Author: Kurokawa, Yasushi; Kanayama, Hiro-Omi; Anwar, Ahmed; Fukumori, Tomoharu; Yamamozo, Yasuyo; Takahashi, Masayuki; Kagawa, Susumu; Murakami, Yosihide; Terachi, Toshiro
Year: 2002
Title: Laparoscopic nephroureterectomy for dysplastic kidney
in children: an initial experience
Journal: International Journal of Urology
Volume: 9
Pages: 613-617


Reference Type: Journal Article
Record Number: 15
Author: Lang, M.; Niskanen, P.; Mietiinen, P.; Alhava, E.; Takala, J.
Year: 2001
Title: British Journal of Surgery
Journal: 88
Pages: 1006-1014
Abstract: Background: A small minority of patients undergoing gastroenterological surgery are at high risk for
postoperative complications, which may lead to prolonged hospital stay, disproportionate use of
resources and increased mortality. The nature and frequency of, and predictive factors for,
postoperative complications were studied and the impact of complications on resource utilization was
assessed.
Methods: A prospective observational study was undertaken of 503 patients undergoing
gastroenterological surgery in a tertiary care centre. The incidence of cardiorespiratory, infective and
surgical complications was assessed. The need for reoperation, intensive care and length of hospital
stay, readmission, death at 6 months and costs were evaluated.
Results: Some 235 patients (47 per cent) had at least one complication, most commonly delayed oral
intake (n = 70). Complications were associated with cardiovascular disease, prolonged operation, high
Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity, and
increased number of Shoemaker's criteria. The length of hospital stay of patients with complications
was longer than that of those without complications (11 versus 6 days). Morbidity resulted in a twofold
increase in median costs.
Conclusion: High-risk patients could be identi®ed by simple clinical criteria, although the commonly
used risk criteria were not very sensitive. A reduction in postoperative complication rates would result
in marked cost savings.


Reference Type: Journal Article
Record Number: 13
Author: McNaught, C.E.; MacFie, J.; Symes, T.; Sowdi, R.; Mitchell, C.J.
Year: 2002
Title: Optimization of surgical care: a prospective randomized trial
Journal: British Journal of Surgery
Volume: 89
Issue: 1
Pages: 37
Abstract: Aims: To investigate the effects of a multimodal rehabilitation package on physical, psychological and clinical outcome in patients after bowel resection compared with a traditional postoperative regimen.

Methods: Patients requiring elective right and left hemicolectomy were randomized to receive the 'optimization package' (see Table) or the standard hospital pre- and postoperative regimen.

Preoperative Intraoperative Postoperative Written and oral
information High inspired oxygen
(80%) Epidural analgesia Preoperative assessment Combined epidural/GA Early oral nutrition Probiotics Transverse incision Enforced mobilization Carbohydrate loading   Early discharge No bowel preparation

Outcome measures of physical function were recorded preoperatively and on days 1, 7 and 30.

Results: Twenty-three patients were randomized, 13 to optimization with 10 controls. The groups were similar in terms of age (62 years versus 69 years), sex (M:F = 5:8 versus M:F = 3:7), POSSUM scores (25 versus 26) and ASA grades. Grip strength was significantly maintained at 24 h in the optimization group (P = 0.03). The time to resume a normal hospital diet was decreased (48 h versus 74 h; P < 0.001). Pain and fatigue scores were significantly reduced in the optimization group on days 1 and 7 (P < 0.05). Cardiopulmonary complications were lower in the optimization group (1/13 (8 per cent) versus 4/10 (40 per cent); P = 0.17). Median length of hospital stay was 3 days (2 7) in the optimization group compared to 7 days (3 10) in controls (P = 0.001).

Conclusion: Optimization of surgical care significantly improves patient's physical and psychological function in the early postoperative period and facilitates early hospital discharge.


Reference Type: Journal Article
Record Number: 2
Author: Nygren, Jonas; Thorell, Anders; Ljungqvist, Olle
Year: 2003
Title: New developments facilitating nutritional intake after gastrointestinal surgery.
Journal: Current Opinion in Clinical Nutrition & Metabolic Care
Volume: 6
Issue: 5
Pages: 593-597


Reference Type: Conference Proceedings
Record Number: 24
Author: Ommer, A.; Peitgen, K.; Walz, M.K.
Year of Conference: 2005
Title: Fast-track Kolonchirurgie - ein neues revolutionäres Konzept
Conference Name: 122. Kongress der Deutschen Gesellschaft für Chirurgie
Conference Location: München
Publisher: Deutsche Gesellschaft für Chirurgie
URL: http://www.egms.de/en/meetings/dgch2005/05dgch337.shtml


Reference Type: Journal Article
Record Number: 22
Author: Ottesen, Marianne; Mette, Sörensen; Rasmussen, Yvonne; Smidt-Jensen, Steen; Kehlet, H.; Ottesen, Bent
Year: 2002
Title: Fast trask vaginal surgery
Journal: Acta Obstetric and Gynecology Scandinavia
Volume: 81
Pages: 133-146
Abstract: Objective. Our aim was to describe the need for postoperative hospitalization after vaginal
surgery for utero-vaginal prolapse with well-defined charts for postoperative care.
Design. A prospective, descriptive study. Consecutive women admitted for first-time vaginal
surgery for utero-vaginal prolapse at a public university hospital in Copenhagen, Denmark,
underwent surgery and postoperative care in a fast track setting from September 15, 1999 to
June 15 2000.
Methods. A multimodal rehabilitation model with emphasis on information, standardized
general anesthesia, reduced surgical distress, optimized pain-relief, early oral nutrition and
ambulation, minimal use of indwelling catheter and vaginal packing.
Outcome measures. Postoperative hospital stay, complications, re-admission, success rate,
patients’ satisfaction and acceptability.
Results. Forty-one women with a median age of 69 years (range, 44­88years) were included.
All underwent anterior and/or posterior vaginal repair. Nineteen (46.3%) underwent vaginal
hysterectomy, and eight (19.5%) underwent the Manchester procedure. Postoperative hospital
stay was median 24hr. Only three (7.3%) were discharged later than 48 hr. No re-admissions
occurred. The most frequent complications were urinary retention exceeding 450ml, and
urinary tract infection (12.2%, and 9.8%, respectively). Short-term success rate was 97.6%.
Patients’ satisfaction rates were 85.4­95.1%. The median score of acceptability was 10 on a
0­10 points scale.
Conclusion. The need for postoperative hospitalization was median 24hr after vaginal surgery
in a fast track setting, independently of the complexity of the procedure performed. Shortterm
success rate, satisfaction rates, and acceptability were all excellent. Follow up has been
established to evaluate long-term success rates and recurrence.


Reference Type: Journal Article
Record Number: 10
Author: Paul, C.; Maasackers, G.; Vestweber, K.H.
Year: 2000
Title: Diät und Kostaufbau nach Gastrektomie
Journal: Chirurgische Gastroenterologie
Volume: 16
Pages: 39-46
Abstract: Malnutrition and severe weight loss are the most frequent complications after total gastrectomy. Malabsorption, due to loss of stomach reservoir with shortened transit time, bacterial overgrowth and relative pancreatic enzyme insuffciency, have been discussed. Other reasons are inadequate calorie intake explained by lack of appetite, early satiety, disturbance of taste and psychological problems. A correct dietary regimen with 40 kcal/kg body weight/day (15-20% protein, 30-40% fat and 50% carbohydrates) is necessary. Before and after discharge from hospital, patients should repeatedly be introduced by an experienced dietitian to increase the intake of energy and nutrient-rich foods, to increase meal frequency to about 6-8 small-sized meals per day, and to separate solid and liquid food items. Food restrictions should be given only in case persistent problems such as dumping, diarrhea or steatorrhea. For malnourished patients or patients with major problems after operation, a home enteral nutrition via catheter jejunostomy can be organized. Malnutrition and sharp weight loss are not inevitable consequences after total gastrectomy. After an adaptive time the patients are able to stabilize their weight or to gain weight, and about 1 year postoperatively most of the totally gastrectomized patients are able to eat the same nutrients as before the operation. Postoperative disturbances in digestion and a decrease in food intake can be avoided with a careful nutritional follow-up and dietary education, especially in the early postoperative period when patients have the most difficulties with taking adequate nutrition.


Reference Type: Journal Article
Record Number: 5
Author: Raue, W.; Hasse, O.; Junghans, T.; Scharfenberg, M.; Müller, J.M.; Schwenk, W.
Year: 2001
Title: 'Fast-track' multimodal rehabilitation program improves outcome after laparoscopic sigmoidectomy: a controlled prospective evaluation
Journal: Surgical Endoscopy
Volume: 18
Issue: 10
Pages: 1463-1468
Abstract: Laparoscopic colorectal resection improves patient outcome by reducing pain, postoperative pulmonary dysfunction, gastrointestinal paralysis, and fatigue. A multimodal rehabilitation program ("fast-track") with epidural analgesia, early oral feeding, and enforced mobilization may further improve the excellent results of laparoscopic colorectal resection, enabling early ambulation of these patients.
Methods:
Fifty two consecutive patients underwent laparoscopic sigmoidectomy with standardized regular perioperative treatment (standard) or multimodal rehabilitation program ("fast-track"). Outcome measures included pulmonary function, duration of postoperative ileus, pain perception, fatigue, morbidity, and mortality.
Results:
Twenty nine standard-care patients (19 men and 10 women) and 23 fast-track patients (15 men and eight women) were evaluated. Demographic and operative data were similar for the two groups. On the 1st postoperative day, pulmonary function was improved (p = 0.01) in fast-track patients. Oral feeding was achieved earlier (p < 0.01) and defecation occurred earlier (p < 0.01) in the fast-track group. Visual analogue scale scores for pain were similar for the two groups (p > 0.05), but fatigue was increased in the standard-care group on the 1st (p = 0.06) and 2nd (p < 0.05) postoperative days. Morbidity was not different for the two groups. Fast-track patients were discharged on day 4 (range, 3-6) and standard-care patients on day 7 (range, 4-14) (p < 0.001).
Conclusion:
Multimodal rehabiliation can improve further on the excellent results of laparoscopic sigmoidectomy and decrease the postoperative hospital stay.


Reference Type: Journal Article
Record Number: 3
Author: Schilder, J.M.; Hurteau, J.A.; Look, K.Y.; Moore, D.H.; Raff, G.; Stehman, F.B.; Sutton, G.P.
Year: 1997
Title: A prospective controlled trial of early postoperative oral intake following major abdominal gynecologic surgery.
Journal: Gynecology and oncology
Volume: 67
Issue: 3
Pages: 235-340
URL: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9441769&dopt=Abstract


Reference Type: Journal Article
Record Number: 6
Author: Schwenk, W.; Hasse, O.; Raue, W.; Neudecker, J.; Müller, J.M.
Year: 2004
Title: Einführung der "Fast-track"-Kolonchirurgiie in den klinischen Alltag
Journal: Zentralbibliothek Chirurgie
Volume: 129
Issue: 6
Pages: 502-509


Reference Type: Journal Article
Record Number: 7
Author: Schwenk, W.; Raue, W.; Paul, C.; Neuß, H.; Müller, J.M.
Year: 2004
Title: Wandel der enteralen Ernährung in der gastrointestinalen Chirurgie
Journal: Viszeralchirurgie
Volume: 39
Issue: 3
Pages: 159-165
Abstract: In recent years growing scientific knowlegde on the perioperative pathophysiology of abdominal surgery has led to the developement of perioperative multimodal rehabiliation programs. These "Fast-track"-Rehabilitation programs were created to improve reconvalescence of patients and reduce the incidence of general complications. One cornerstone of "Fast-track"-rehabilitation after major abdominal surgery is early oral feeding. Consequent utilization of thoracic epidural analgesia, avoidance of systemic opioids and systemic basal analgesia with non-opioid-analgetics, minimal invasive surgery or modified conventional approaches to the abdominal cavity, perioperative restriction of infusions and enforced postoperative mobilisation allow for early oral feeding even after major procedures. The pathophysiological basics or "Fast-track"-rehabilitation and their value in the clinical routine will be summarized and discussed in the following manuscript.


Reference Type: Journal Article
Record Number: 28
Author: Schwenk, W.; Raue, W.; Hasse, O.; Junghans, T.; Müller, J.M.
Year: 2004
Title: "Fast-track-Kolonchirurgie" - Erste Erfahrungen mit einem "clinical pathway" zur Beschleunigung der postoperativen Rekonvaleszenz
Journal: Der Chirurg
Volume: 75
Issue: 5
Pages: 508-514
Abstract: bstract Object. The aim of multimodal perioperative treatment concepts is to lower the extent of general complications after elective colonic resection and "traditional" perioperative therapy and to allow hospital discharge only a few days following the operation. Materials and methods. In this prospective study, we examined a new perioperative treatment plan for accelerating postoperative recovery and evaluated the results. This so-called "fast-track" program employs combined thoracal peridural analgesia, forced mobilization, and rapid renourishment within the clinic. Results. Sixty-four consecutive patients with benign or malignant disease of the large intestine aged an average of 66 years (range 54-71) were operated on. Thirty received conventional resection and 34 were operated on laparoscopically and treated perioperatively using the fast-track program. The hospital diet was given in all cases on the 1st postoperative day, and the first bowel movement occurred on the 2nd day (range 2-3). The patients could be released on the 4th postresection day (range 4-5). General and local postoperative complications were observed in five patients each (8%), including two cases of anastomotic insufficiency. Conclusion. In colonic surgery, the "fast-track" method accelerated convalescence, lowered the number of general complications, and reduced the duration of hospital stay. Therefore, evaluation of "fast-track" concepts is warranted in other types of elective abdominal surgery.
Zusammenfassung Einleitung. Die Rate allgemeiner Komplikationen nach elektiven Kolonresektionen und "traditioneller" perioperativer Therapie soll durch multimodale perioperative Behandlungskonzepte reduziert werden und eine Entlassung innerhalb weniger Tage nach der Operation ermoeglichen. Material und Methoden. In einer prospektiven Untersuchung wurde ein perioperatives Behandlungskonzept zur Beschleunigung der postoperativen Rekonvaleszenz ("Fast-track-Programm") mit thorakaler kombinierter Periduralanalgesie, forcierter Mobilisation und raschem Kostaufbau in der Klinik eingefuehrt und die Ergebnisse kritisch evaluiert. Ergebnisse. 64 konsekutive Patienten mit benignen oder malignen Dickdarmerkrankungen im Alter von 66 (54-71) Jahren wurden konventionell (n=30) oder laparoskopisch (n=34) reseziert und perioperativ mit dem "Fast-track-Programm" behandelt. Die Krankenhausbasisdiaet wurde am 1. (1-1) postoperativen Tag vertragen, der erste Stuhlgang erfolgte am 2. (2-3) Tag. Die Entlassung der Patienten war am 4. (4-5) Tag nach der Resektion moeglich. Allgemeine und lokale postoperative Komplikationen wurden bei jeweils 5 Patienten (8%) beobachtet, darunter 2 Anastomoseninsuffizienzen (3%). Schlussfolgerung. Die "Fast-track-Kolonchirurgie" beschleunigt die Rekonvaleszenz und reduziert die Quote allgemeiner Komplikationen sowie die postoperative Verweildauer. Eine weitere Evaluation von "Fast-track-Konzepten" nach anderen elektiven abdominellen Eingriffen erscheint deshalb sinnvoll.


Reference Type: Journal Article
Record Number: 31
Author: Schwenk, W.; Raue, W.; Hasse, O.; Junghans, J.M.; Müller, J.M.
Year: 2004
Title: "Fast-track-Kolonchirurgie"
Journal: Chirurg
Volume: 75
Issue: 5
Pages: 508-514


Reference Type: Journal Article
Record Number: 4
Author: Schwenk, W.; Spies, C.; Müller, J.M.
Year: 2005
Title: Beschleunigte Frührehabilitation in der operativen Medizin: Fast-Track-Rehabilitation
Journal: Deutsches Ärzteblatt
Volume: 102
Issue: 21
Pages: 1514
Abstract: Zusammenfassung Unter traditioneller perioperativer Behandlung gehen operative Eingriffe mit einer deutlich verz?gerten Rekonvaleszenz der Patienten einher. Die Ursachen dieser verlangsamten Genesung sind vielf?ltig und in experimentellen und klinischen Studien gut untersucht. Fast-track-Rehabilitation ist ein interdisziplin?res, multimodales Konzept zur Beschleunigung der postoperativen Rekonvaleszenz und Vermeidung allgemeiner Komplikationen. Die Einzelkomponenten sind durch randomisierte kontrollierte Studien analysiert worden. Im Mittelpunkt dieses Konzeptes stehen neben der Patienteninformation und -vorbereitung die effektive perioperative Schmerztherapie (beispielsweise durch thorakale Periduralanalgesie) unter Vermeidung hoher systemischer Opioiddosen, die forcierte Mobilisation der Patienten und der rasche Kostaufbau auch nach intraabdominalen Eingriffen. Erg?nzt werden diese Ma§nahmen durch ein optimiertes Patientenmanagement (zum Beispiel ad?quate FlÙssigkeitstherapie, Vermei...


Reference Type: Journal Article
Record Number: 8
Author: Senkal, M.; Zumtobel, V.; Eickhoff, U.
Year: 2000
Title: Frühe enterale Ernährung - Grenzen und Möglichkeiten
Journal: Chirurgische Gastroenterologie
Volume: 16
Pages: 33-38
Abstract: Enteral nutrition is an economic and effective way for nutritional support in the posttraumatic and postoperative phase. Early enteral nutrition may preserve the nitrogen balance, the structure and function of the gut mucosa as well as the immune competence. However, there is no consensus about the administration of early enteral nutrition, which reduces its use in the clinical routine. Suitable enteral accesses are of critical importance for the concept of early enteral nutrition after trauma or elective abdominal surgery. Different nasoenteral tubes are usable in patients who are not laparotomized. If a laparotomy is performed, nasoenteral tubes as well as intraoperatively placed percutaneous tubes (e. g. needle catheter jejunostomy) can be used for early enteral nutrition. Enteral feeding should start within 12-24 h after trauma or operation, not only to prevent structural damages of the gut mucosa but also to improve the tolerability and practicability of enteral feeding. Further, the motility of the gastrointestinal tract can be improved if enteral nutrition is started early. A delayed start of substrate administration is not beneficial for the homeostasis of patients. Enteral nutrition should be increased gradually in the days foIlowing surgery. Early enteral nutrition can be performed either with a nonelemental diet or by immunonutrition. Elemental diets are usually not indicated. For monitoring of the early enteral nutrition frequent clinical investigations are necessary. If complications like diarrhea or distension occur, feeding should be reduced or, if necessary, temporarily stopped.


Reference Type: Conference Proceedings
Record Number: 25
Author: Spatz, H.; Beham, A.; Fürst, A.; Zülke, C; Schlitt, H.J.
Year of Conference: 2005
Title: "Fast Track" bei laparoskopisch assistierter Rektumresektion - was kann erreicht werden ?
Conference Name: 122. Kongress der Deutschen Gesellschaft für Chirurgie
Conference Location: München
Publisher: Deutsche Gesellschaft für Chirurgie
URL: http://www.egms.de/en/meetings/dgch2005/05dgch336.shtml


Reference Type: Conference Proceedings
Record Number: 26
Author: Wichmann, M.W.; brandenburg, F.; Goetz, A.; Jauch, K.W.
Year of Conference: 2005
Title: Immunologische Effekte der multimodalen Rehabilitation im Rahmen der koloreaktalen Chirurgie - eine prospektive klinische Studie
Conference Name: 122. Kongress der Deutschen Gesellschaft für Chirurgie
Conference Location: München
Publisher: Deutsche Gesellschaft für Chirurgie
URL: http://www.egms.de/en/meetings/dgch2005/05dgch336.shtml


Reference Type: Journal Article
Record Number: 23
Author: Zykla-Menhorn, V.
Year: 2004
Title: Schmerztherapie: Ein Qualitätsmerkmal für chirurgische Abteilungen
Journal: Deutsches Ärzteblatt
Volume: 101
Issue: 5
Pages: 231
Abstract: Defizite in der Akutschmerztherapie sind auch in der mangelhaften Aus- und Weiterbildung von ¤rzten begrÙndet. Unter Umst?nden ist der Chirurg mit seiner Operation zufriedener als der Patient. BezÙglich des postoperativen Schmerzes beschreibt dieses 100 Jahre alte Zitat des DÙsseldorfer Chirurgen Oscar Witzel heute noch klinische Realit?t. Nach wie vor werden in zu vielen Kliniken Schmerzen nach dem Eingriff als unvermeidbar hingenommen, kritisierte Prof. Edmund Neugebauer (Universit?t K?ln) bei einem Symposium der Deutschen Gesellschaft zum Studium des Schmerzes (DGSS) in K?ln. Als langj?hriger Verfechter fÙr eine ad?quate Schmerztherapie in der Chirurgie empfiehlt er seinen Kollegen, sich ein st?rkeres Schmerzbewusstsein anzueignen, da die perioperative Analgesie auch dazu beitrage, Folgesch?den zu verhindern. Frischoperierte, die unter Schmerzen leiden, entwickeln h?ufiger tiefe Venenthrombosen, Lungenembolien und Pneumonien, sagte Neugebauer. Dass die postoperative Schmerztherapie ...