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Colorectal surgery

Key sources
The following summarized guidelines for the management of colorectal surgery are prepared by our editorial team based on guidelines from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES/ASCRS 2023), the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES/ESCP/EAES 2023), the American Society of Colon and Rectal Surgeons (ASCRS 2022; 2019; 2017; 2013), and the Enhanced Recovery After Surgery Society (ERASS 2019).
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Guidelines

1.Perioperative care

Prehabilitation: as per SAGES 2023 guidelines, consider providing multimodal prehabilitation before elective colorectal surgery in patients with multiple comorbidities or significant deconditioning.
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  • Preoperative nutrition

  • Preoperative optimization

  • Preoperative preparation

  • Preoperative anxiolytic premedication

  • Perioperative nausea and vomiting prophylaxis

  • Perioperative hemodynamic control

  • Perioperative antibiotic prophylaxis

  • Perioperative thromboprophylaxis

  • Anesthesia and analgesia

2.Surgical interventions

Surgical approach: as per ASCRS 2023 guidelines, use a minimally invasive surgical approach for colorectal resection when appropriate and provided expertise is available.
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  • Skin preparation

  • Intra-abdominal drains and nasogastric tubes

  • Ostomy surgery (choice of approach)

  • Ostomy surgery (preoperative marking)

  • Ostomy surgery (ostomy creation)

  • Ostomy surgery (ostomy closure)

  • Ostomy surgery (parastomal hernia repair)

3.Patient education

Preoperative counseling
As per SAGES 2023 guidelines:
Conduct a preoperative discussion regarding clinical milestones and discharge criteria.
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Provide preoperative stoma teaching and counseling regarding how to avoid dehydration in patients undergoing ileostomy creation.
B

4.Follow-up and surveillance

General principles: as per SAGES 2023 guidelines, consider offering hospital discharge before the return of bowel function in selected patients after colorectal resection.
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  • Early mobilization

  • Postoperative glycemic control

  • Postoperative ileus prevention

  • Postoperative nutrition

  • Urinary drainage

  • Urinary drainage (ERAS)