Effect of different treatment modalities in colorectal surgery on postoperative gastrointestinal motility.

Recent developments in large bowel surgery are the introduction of laparoscopic surgery and the implementation of multimodal fast track recovery programs. Both focus on a faster recovery and shorter hospital stay. Time untill recovery of gastrointestinal motility is the major determinant of length of hospital stay.
The randomized controlled LAFA-site study (LAparoscopy and/or FAst track multimodal management versus standard care) was conceived to determine whether laparoscopic surgery, fast track perioperative care or a combination of both is to be preferred over open surgery with standard care with regard to postoperative gastrointestinal motility.
Patients eligible for segmental colectomy for malignant colorectal disease will be randomized to either:

1. Open colectomy with fast track;

2. Laparoscopic colectomy with standard care;

3. Laparoscopic surgery with fast track.

Primary outcome parameter is postoperative gastrointestinal transit. Secondary outcome parameters are signs and symptoms of postoperative gastrointestinal motility.

It can be hypothesized that fast track care and/or laparoscopy are associated with less exaggerated inflammatory response during and after surgery resulting in faster recovery of postoperative gastrointestinal motility.

Postoperative day 1, 2,and 3 and for secondary outcomes every day untill discharge.

4 different treatment arms for patients eligible for segmental colectomy for malignant colorectal disease:

1. Laparoscopic surgery + fast track care*;

2. Laparoscopic surgery + standard care;

3. Open surgery + fast track care*;

4. Open surgery + standard care.



*Multimodal fast track perioperative recovery program which focusses on shorter hospital stay and faster recovery.