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Known as Enhanced Recovery After Surgery -- or ERAS -- the strategy includes a series of steps before, during and after colorectal surgery for cancer or benign diseases.
“ERAS not only shortens hospital stays, but it reduces the need for opioid painkillers,” said Dr. Lee Fleischer, a surgeon with Highland Medical, P.C., Highland Surgical Associates and director of the Department of Surgery at Montefiore Nyack Hospital. “It achieves these goals without decreasing the effectiveness of the surgery or cure rates.”
The first steps in ERAS start before surgery: patients should begin exercising and stop smoking. “We encourage patients to stop smoking immediately, to give the body as much time as possible to start to repair itself before surgery,” said Fleischer.
The day before surgery, patients undergo a “bowel prep”-- a familiar routine to anyone who has had a colonoscopy. This typically includes a liquid diet and various preparations to cleanse the bowels.
Four hours before surgery, patients drink a high-carbohydrate eight-ounce liquid drink to improve their nutritional status right before surgery. “In the past, patients were told not to eat or drink anything after midnight the night before surgery,” said Fleischer said. “With ERAS, the patient doesn’t have to starve before surgery.”
Before surgery starts, the anesthesiologist will use a Transversus Abdominis Plane (TAP) block to numb the abdominal wall for three to four days. This type of anesthesia decreases the need for opioid painkillers after surgery, and reduces the risk of further complications. “Previously, we didn’t use TAP blocks, so pain control wasn’t as good," said Fleischer.
The surgical procedure is done using minimally invasive surgery, which also reduces recovery time. After surgery, patients spend time in a recovery room, and then are encouraged to walk, or at least sit in a chair the rest of the day. Three days later, they will go home.
“In the past, patients didn’t start moving and eating until much later, which delayed the start of their recovery,” said Fleischer. “Now that patients start walking and eating sooner, they heal better and go home faster.”
To learn more about the colorectal services offered by Highland Medical, click here.
