OPTIMIZATION OF PRE-, INTRA- AND POST-OPERATIVE SURGICAL MANAGEMENT IN PATIENTS AFFECTED BY INFLAMMATORY BOWEL DISEASE

Inflammatory bowel diseases (IBDs) are immune system disorders characterized by a chronic course with remissions and relapses. IBD includes two related but distinct disorders: Crohn’s disease (CD) and ulcerative colitis (UC) . Despite advances in the medical management of CD, approximately 25% to 80% of the patients with Crohn’s disease need surgery within 10 years of diagnosis. In addition, 40-50% of patients that receive surgical treatment for Crohn's will require further surgery within the next 10-15 years. In UC about 40% of patients with severe disease require proctocolectomy. The fast track protocol is an evidence-based care program including preoperative, intraoperative and postoperative items and it was introduced about 20 years ago by Kehlet et al. to reduce perioperative stress, improve patient outcomes, achieve faster recovery, shorten length of hospital stay (LOS), without compromising the safety of the patients. However, the application of fast track protocol in IBD is not still diffuse. The aim of this study was to implement the pre-, intra- and post-operative phases adopting nutritional prehabilitation, minimally invasive surgery with fast track protocol and to evaluate the effect of these approaches on surgical outcome and length of hospital stay.