Comparison of Early Mobilization and Diet Rehabilitation Program With Conventional Care After Laparoscopic Colon Surgery: A Prospective Randomized Controlled Trial

• Published in: Diseases of the colon & rectum Vol. 54; no. 1; pp. 21 - 28
• Main Authors: Lee, Taek-Gu, Kang, Sung-Bum, Kim, Duck-Woo, Hong, Samin, Heo, Seung Chul, Park, Kyu Joo
• Format: Journal Article
• Language: English
• Published: Hagerstown, MDc The ASCRS 01.01.2011; Lippincott Williams & Wilkins
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Chi-Square Distribution; Colonic Diseases - diet therapy; Colonic Diseases - rehabilitation; Colonic Diseases - surgery; Colorectal Surgery; Early Ambulation; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Laparoscopy; Laxatives - administration & dosage; Length of Stay - statistics & numerical data; Male; Medical sciences; Middle Aged; Miscellaneous; Pain Measurement; Pain, Postoperative - prevention & control; Prospective Studies; Quality of Life; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Statistics, Nonparametric; Surveys and Questionnaires; Treatment Outcome; Mobilization; Multimodal rehabilitation; Diet; Gastroenterology; Laparoscopic surgery; Colon; Rehabilitation; Randomized controlled trial; Comparative study; Care
• ISSN: 0012-3706; 1530-0358
• DOI: 10.1007/DCR.0b013e3181fcdb3e

PURPOSE:Although laparoscopic surgery may permit earlier recovery compared with open surgery, no published randomized controlled trial has investigated the benefit of a multimodal rehabilitation program after laparoscopic colonic resection. This study aimed to evaluate the efficacy of a rehabilitation program after laparoscopic colon surgery in the context of a randomized controlled trial. METHODS:Between September 2007 and October 2009, 100 patients who had received laparoscopic colon surgery were selected for the study and randomly assigned on a 1:1 basis to a rehabilitation program group with early mobilization and diet (n = 46) or conventional care group (n = 54). The rehabilitation program group received early oral feeding, early ambulation, and regular laxative. The primary outcome was recovery time, measured with criteria of tolerable diet for 24 hours, safe ambulation, analgesic-free, and afebrile status without major complications. Secondary outcomes were postoperative hospital stay, complications, quality of life by Short Form 36, pain by visual analog scale, and readmission. This study was registered (ID number NCT00606944, http://register.clinicaltrials.gov). RESULTS:Recovery time was shorter in the rehabilitation program group than in the conventional care group (median (interquartile range), 4 (3–5) d vs 6 (5–7) d, respectively; P < .0001). There was no difference in postoperative hospital stay between the 2 groups (rehabilitation program group, 7 (6–8) d vs conventional care group, 8 (7–9) d; P = .065). There was no difference in complication rates between the rehabilitation program group and conventional care group (10.9% vs 20.4%, respectively; P = .136). Quality of life and pain were similar in both groups. There were no readmissions or mortality. CONCLUSIONS:A rehabilitation program with early mobilization and diet after laparoscopic colon surgery results in reduced recovery time without increased complications. These results suggest that a multimodal rehabilitation program may increase the short-term benefits after laparoscopic colon surgery.