1. Preoperative counselling and patient’s education | |
2. No bowel preparation (oral lavage in the case of low rectal resection with TME and defunctioning loop ileostomy) | |
3. Preoperative carbohydrate loading (400 ml of Nutricia preOp® 2 h prior surgery) | |
4. Antithrombotic prophylaxis (Clexane® 40 mg sc. starting in the evening prior surgery) | |
5. Antibiotic prophylaxis (preoperative cefuroxime 1.5 g + metronidazole 0.5 g i.v. 30–60 min prior surgery) | |
6. Laparoscopic surgery | |
7. Balanced intravenous fluid therapy (<2500 ml intravenous fluids during the day of surgery, less than 150 mmol sodium) | |
8. No nasogastric tubes postoperatively | |
9. No drains left routinely for colonic resections, one drain placed for <24 h in case of TME | |
10. TAP (transversus abdominis plane) block, epidural anaesthesia in cases with high risk of conversion | |
11. Avoiding opioids, multimodal analgesia (oral when possible—paracetamol 4 × 1 g, ibuprofen 2 × 200 mg, metamizole 2 × 2.5 g, or ketoprofen 2 × 100 mg) | |
12. Prevention of postoperative nausea and vomiting (PONV) (dexamethasone 8 mg i.v., ondansetron 8 mg i.v., metoclopramide 10 mg i.v.) | |
13. Postoperative oxygenation therapy (4–6 l/min.) | |
14. Early oral feeding (oral nutritional supplement 4 h postoperatively, light hospital diet and oral nutritional supplements on the first postoperative day, full hospital diet in the second postoperative day) | |
15. Urinary catheter removal on the first postoperative day | |
16. Full mobilisation on the first postoperative day (getting out of bed, going to toilet, walking along the corridor, at least 4 h out of bed) |