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Both laparoscopic surgery and ERPs result in improved outcomes when used in isolation. But additional benefits are seen when they are combined. In a large multicenter trial where patients were allocated to four groups combining surgical approach (laparoscopic or open) and perioperative care (enhanced recovery or standard), the combination of MIS and ERP resulted in the shortest hospital stay (1). Laparoscopy was a stronger influence on inflammation, reduced hospital stay and morbidity, with both laparoscopy and ERP independent predictors of faster colonic transit, earlier time to tolerance of solid food and defecation (2). Cochrane review of 3 RCTs and 6 case controlled studies found that the addition of an ERP to laparoscopic colectomy reduced length of stay without affecting morbidity (3). In a large multicenter registry, both laparoscopic surgery and increasing adherence with ERP elements were associated with shorter hospital stay and reduced complications (4).
For more information, see Chapter 21: Why Add an ERP to a Laparoscopic Case: The Colorectal Experience in The SAGES / ERAS® Society Manual of Enhanced Recovery Programs for Gastrointestinal Surgery
1. Vlug MS, Wind J, Hollmann MW, Ubbink DT, Cense HA, Engel AF, et al. Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Annals of surgery. 2011;254(6):868-75.
2. van Bree SH, Vlug MS, Bemelman WA, Hollmann MW, Ubbink DT, Zwinderman AH, et al. Faster recovery of gastrointestinal transit after laparoscopy and fast-track care in patients undergoing colonic surgery. Gastroenterology. 2011;141(3):872-80 e1-4.).
3. Spanjersberg WR, van Sambeeck JD, Bremers A, Rosman C, van Laarhoven CJ. Systematic review and meta-analysis for laparoscopic versus open colon surgery with or without an ERAS programme. Surg Endosc. 2015 Mar 24. [Epub ahead of print].
4. Currie A, Burch J, Jenkins JT, Faiz O, Kennedy RH, Ljungqvist O, Demartines N, Hjern F, Norderval S, Lassen K, Revhaug A, Koczkas T, Nygren J, Gustafsson U, Kornfeld D, Slim K, Hill A, Soop M, Carlander J, Lundberg O, Fearon K. The Impact of Enhanced Recovery Protocol Compliance on Elective Colorectal Cancer Resection: Results From an International Registry. Ann Surg. 2015 Jan 23. [Epub ahead of print]