الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Enhanced recovery protocols have been proved to improve the outcomes of colorectal resections patients. Not only do patients benefit from these programs, but also the entire health care community is affected positively. Better pain control, faster return of gut functions, fewer complications and faster hospital leave are the outcomes of improving the physiological response to surgery. It is of value to note that these fast track protocols eventually lead to quicker return to normal daily activities with a better feeling of well-being and full recovery. The outcomes of surgery are improved resulting in lower incidence of long-term complications i.e. incisional hernias and intestinal obstruction. Although the present findings are directly applicable only to relatively fit patients undergoing hemicolectomy, similar results have been demonstrated in patients with significant co-morbidity undergoing more extensive surgery. It is likely that the optimization package used in this study would benefit such patients; further randomized trials are required. All of the fifteen points adopted in this optimization package have direct or indirect effects on gut functions. Giving patients adequate information before surgery leads to expectation of a normal intake. Preoperative carbohydrate loading is well known to reduce postoperative insulin resistance, but is also associated with normalization of intestinal tolerance. Avoidance of opiates, judicious use of drains and avoidance of bowel preparation all contribute to preservation of gut function. Few would disagree that early mobilization encourages normalization of intestinal activity. Fast-track protocol was followed by a significantly reduced hospital stay and better outcome for patients from the point of view of early refeeding and mobilization. Fast- track protocol did not increase the incidence of complications. Conclusion: The application of enhanced recovery programs in colorectal surgery within the Egyptian health system is quite feasible and allows for improved and more rapid recovery of surgical patients without increasing rates of complications and leads to an early discharge of the patient from the hospital.