• Antonino Spinelli, Piero Bazzi, Matteo Sacchi, Silvio Danese, Gionata Fiorino, Alberto Malesci, Lorenzo Gentilini, Gilberto Poggioli, and Marco Montorsi.
• Department and Chair of General Surgery, Istituto Clinico Humanitas-IRCCS, University of Milan, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy. antonino.spinelli@humanitas.it
• J. Gastrointest. Surg. 2013 Jan 1;17(1):126-32; discussion p.132.

BackgroundLaparoscopy combined with an enhanced recovery pathway (ERP) is widely considered to be the first-choice option for patients with colorectal cancer. However, no previous reports have focused on patients with Crohn's disease (CD) treated by laparoscopy and ERP.MethodsTwenty patients with CD underwent laparoscopic ileocecal resection with an ERP at two institutions. The ERP protocol included no bowel preparation nor fasting, no nasogastric tube, no abdominal drains, early removal of urinary catheter, early solid dietary intake and mobilization, opioid-sparing analgesia and restrictive fluid management. This group was compared with a matched historical control group of 70 CD patients who underwent laparoscopic ileocecal resection treated with conventional care.ResultsCompliance with the ERP was high (≥80 %) for all items except no drain placement. A significantly earlier return of bowel function (time to first flatus and stool) was observed in the ERP group. Mean postoperative and total length of stay were significantly shorter in the ERP group. Postoperative complications were similar in both groups.ConclusionsThis is the first reported experience of laparoscopy with ERP in CD patients and suggests that optimized perioperative care combined with minimally invasive techniques may lead to further improvements in surgical outcomes for CD patients.

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