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Colorectal surgery

What's new

Added 2023 ASCRS/SAGES, 2023 EAES/SAGES, and 2019 ERASS guidelines on colorectal surgery.

Guidelines

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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Perioperative care

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

Surgical interventions

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

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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)

Specific circumstances

Elderly patients: as per ASCRS 2022 guidelines, take into account the degree of frailty (physiological age) rather than chronological age of patients when making treatment decisions about colorectal surgery.
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Patient education

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

Follow-up and surveillance

General principles: as per ASCRS/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)