Comparison of Early Mobilization and Diet Rehabilitation Program With Conventional Care After Laparoscopic Low Anterior Resection: A Prospective Randomized Controlled Trial

Sung-min Lee, MD, Je-ho Jang, MD, Duck-woo Kim, PhD, Seung-chul Heo, PhD, Seung-yong Jeong, PhD, Kyu-ju Park, PhD, Sung-bum Kang, PhD. Department of Surgery, Seoul National University College of Medicine , Seoul National University Bundang Hospital, Seoul National University Boramae Hospital, Seoul National University Hospital

 

Purpose: Although the early recovery program was reported to be effective after laparoscopic colectomy compared to conventional care, it is not reported about the efficacy of fast-track program after rectal cancer surgery. This study aimed to evaluate the efficacy of a rehabilitation program after laparoscopic low anterior resection in a randomized controlled trial. Methods: Between July 2007 and September 2011, 98 patients who had received laparoscopic low anterior resection with defunctioning temporary ileostomy were accrued to the study and randomized on a 1:1 basis to a rehabilitation program group with early mobilization and diet (n = 52) or conventional care group (n = 46). The rehabilitation program group received early oral feeding, early ambulation, early removal of urinary catheter 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 analogue scale and readmission. This study was registered (registration number NCT00606944, http://register.clinicaltrials.gov). Results: Recovery time was not different in both groups (rehabilitation program group, 7.2 (5-8.3) days vs. conventional care group, 7.1 (5-8) days, P=0.791). There was no difference in postoperative hospital stay between the two groups (rehabilitation, 8.7 (7-10.75) days vs. conventional, 8.3 (7-10) days; P=0.436). There was no difference in complication rates between the rehabilitation program group and conventional care group, but more complications were noted in the rehabilitation program group (42% vs. 24%; P=0.051), which was related to high postoperative ileus (25% vs. 13%, P=0.135) and acute urinary retention (17.3% vs. 4.3%, P=0.056). Quality of life and pain were similar in both groups. Conclusions: This randomized trial does not support that a rehabilitation program with early mobilization and diet is beneficial after laparoscopic low anterior resection.


Session Number: SS20 – Colorectal
Program Number: S112

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