Original Article
ERAS
- Clinical impact of a multimodal pain management protocol for loop ileostomy reversal
-
Jeong Sub Kim, Chul Seung Lee, Jung Hoon Bae, Seung Rim Han, Do Sang Lee, In Kyu Lee, Yoon Suk Lee, In Kyeong Kim
-
Ann Coloproctol. 2024;40(3):210-216. Published online June 19, 2024
-
DOI: https://doi.org/10.3393/ac.2022.01137.0162
-
-
2,907
View
-
200
Download
-
3
Web of Science
-
4
Citations
-
Graphical Abstract
Abstract
PDF

- Purpose
As introduced, multimodal pain management bundle for ileostomy reversal may be considered to reduce postoperative pain and hospital stay. The aim of this study was to evaluate clinical efficacy of perioperative multimodal pain bundle for ileostomy.
Methods
Medical records of patients who underwent ileostomy reversal after rectal cancer surgery from April 2017 to March 2020 were analyzed. Sixty-seven patients received multimodal pain bundle protocol with ileostomy reversal (group A) and 41 patients underwent closure of ileostomy with conventional pain management (group B).
Results
Baseline characteristics, including age, sex, body mass index, American Society of Anesthesiologists classification, diabetes mellitus, and smoking history, were not significantly different between the groups. The pain score on postoperative day 1 was significant lower in group A (visual analog scale, 2.6 ± 1.3 vs. 3.2 ± 1.2; P = 0.013). Overall consumption of opioid in group A was significant less than group B (9.7 ± 9.5 vs. 21.2 ± 8.8, P < 0.001). Hospital stay was significantly shorter in group A (2.3 ± 1.5 days vs. 4.1 ± 1.5 days, P < 0.001). There were no significant differences between the groups in postoperative complication rate.
Conclusion
Multimodal pain protocol for ileostomy reversal could reduce postoperative pain, usage of opioid and hospital stay compared to conventional pain management.
-
Citations
Citations to this article as recorded by

- Immunological changes and recovery-related factors in older patients with colon cancer: A pilot trial
Byeo Lee Lim, Young Il Kim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Yousun Ko, Kyung Won Kim, In Ja Park
Journal of Geriatric Oncology.2025; 16(3): 102200. CrossRef - Multimodal analgesia for postoperative pain: pursuing liberation from pain, not redemption
Soo Yeun Park
Annals of Coloproctology.2024; 40(3): 189. CrossRef - Clinical outcomes and future directions of enhanced recovery after surgery in colorectal surgery: a narrative review
Ji Hyeong Song, Minsung Kim
The Ewha Medical Journal.2024;[Epub] CrossRef - Optimizing postoperative pain management in minimally invasive colorectal surgery
Soo Young Lee
Annals of Coloproctology.2024; 40(6): 525. CrossRef
Editorial
Original Articles
Malignant disease,Prognosis and adjuvant therapy,Functional outcomes,Colorectal cancer,Postoperative outcome & ERAS
- Clinical validation of implementing Enhanced Recovery After Surgery protocol in elderly colorectal cancer patients
-
Wooree Koh, Chul Seung Lee, Jung Hoon Bae, Abdullah Al-Sawat, In Kyu Lee, Hyeong Yong Jin
-
Ann Coloproctol. 2022;38(1):47-52. Published online July 21, 2021
-
DOI: https://doi.org/10.3393/ac.2021.00283.0040
-
-
4,385
View
-
186
Download
-
13
Web of Science
-
15
Citations
-
Abstract
PDF
Supplementary Material
- Purpose
The aim of this study was to evaluate the safety and feasibility of applying enhanced recovery after surgery (ERAS) protocol in elderly colorectal cancer patients.
Methods
The medical records of patients who underwent elective colorectal cancer surgery at our institution, from January 2017 to December 2017, were reviewed. Patients were divided into 2 groups: the young group (YG, patients aged 70 and under 70 years) and the old group (OG, patients over 70 years old). Perioperative outcomes and length of hospital stay were compared between both groups.
Results
In total, 335 patients were enrolled; 237 were YG and 98 were OG. Despite the poorer baseline characteristics of OG, the perioperative outcomes were similar. Length of hospital stay was not different between the groups (YG, 5 days vs. OG, 5 days; P=0.320). When comparing the postoperative complications using the comprehensive complication index (CCI), there was no significant difference (YG, 8.0±13.2 vs. OG, 11.7±23.0; P=0.130). In regression analysis, old age (>70 years) was not a risk factor for high CCI in all patients. In multivariate analysis, C-reactive protein (CRP) level on postoperative day (POD) 3 to 4 was the only strong predictive factor for high CCI in elderly patients.
Conclusion
Implementing the ERAS protocol in patients aged >70 years is safe and feasible. High CRP (≥6.47 mg/dL) on POD 3 to 4 can be used as a safety index to postpone discharge in elderly patients.
-
Citations
Citations to this article as recorded by

- Perioperative outcomes of laparoscopic low anterior resection using ArtiSential® versus robotic approach in patients with rectal cancer: a propensity score matching analysis
I. K. Kim, C. S. Lee, J. H. Bae, S. R. Han, W. Alshalawi, B. C. Kim, I. K. Lee, D. S. Lee, Y. S. Lee
Techniques in Coloproctology.2024;[Epub] CrossRef - Challenging issues of implementing enhanced recovery after surgery programs in South Korea
Soo-Hyuk Yoon, Ho-Jin Lee
Anesthesia and Pain Medicine.2024; 19(1): 24. CrossRef - Effects of the enhanced recovery after surgery (ERAS) protocol on the postoperative stress state and short‐term complications in elderly patients with colorectal cancer
He Han, Rong Wan, Jixiang Chen, Xin Fan, LiWen Zhang
Cancer Reports.2024;[Epub] CrossRef - Sex Disparities in Rectal Cancer Surgery: An In-Depth Analysis of Surgical Approaches and Outcomes
Chungyeop Lee, In Ja Park
The World Journal of Men's Health.2024; 42(2): 304. CrossRef - Application of ERAS in older patients with gastric cancer
Kuanxuan You, He Han
Medicine.2024; 103(22): e38409. CrossRef - Clinical outcomes and future directions of enhanced recovery after surgery in colorectal surgery: a narrative review
Ji Hyeong Song, Minsung Kim
The Ewha Medical Journal.2024;[Epub] CrossRef - Correlation between inflammatory markers and enhanced recovery after surgery (ERAS) failure in laparoscopic colectomy
Ji Hyeong Song, Yoonsoo Shin, Kyung Ha Lee, Ji Yeon Kim, Jin Soo Kim
Surgery Today.2024;[Epub] CrossRef - Beyond the Operating Room: A Narrative Review of Enhanced Recovery Strategies in Colorectal Surgery
Hamed Ibrahim Hamed Albalawi, Rawshan Khalid A Alyoubi, Nawaf Mohsen Mubarak Alsuhaymi, Farha Abdullah K Aldossary, Alkathiry Abdulrahman Mohammed G, Fayez Mubarak Albishi, Jumana Aljeddawi, Fedaa Ahmed Omar Najm, Neda Ahmed Najem, Mohamed Mirza Ali Alma
Cureus.2024;[Epub] CrossRef - Impact of Early Oral Feeding on Postoperative Outcomes after Elective Colorectal Surgery: A Systematic Review and Meta-Analysis
Soo Young Lee, Eon Chul Han
Digestive Surgery.2024; : 1. CrossRef - Enhanced recovery after colorectal surgery is a safe and effective pathway for older patients: a pooling up analysis
Xu-Rui Liu, Xiao-Yu Liu, Bin Zhang, Fei Liu, Zi-Wei Li, Chao Yuan, Zheng-Qiang Wei, Dong Peng
International Journal of Colorectal Disease.2023;[Epub] CrossRef - Effects of preoperative bicarbonate and lactate levels on short-term outcomes and prognosis in elderly patients with colorectal cancer
Xiao-Yu Liu, Zi-Wei Li, Bin Zhang, Fei Liu, Wei Zhang, Dong Peng
BMC Surgery.2023;[Epub] CrossRef - The Latest Results and Future Directions of Research for Enhanced Recovery after Surgery in the Field of Colorectal Surgery
Min Ki Kim
The Ewha Medical Journal.2023;[Epub] CrossRef - Influence of the COVID-19 Pandemic on the Treatment Patterns and Outcomes of Colorectal Cancer
In Ja Park
The Ewha Medical Journal.2023;[Epub] CrossRef - Future direction of Enhanced Recovery After Surgery (ERAS) program in colorectal surgery
In Ja Park
Annals of Coloproctology.2022; 38(1): 1. CrossRef - Implementation and improvement of Enhanced Recovery After Surgery protocols for colorectal cancer surgery
Bo Yoon Choi, Jung Hoon Bae, Chul Seung Lee, Seung Rim Han, Yoon Suk Lee, In Kyu Lee
Annals of Surgical Treatment and Research.2022; 102(4): 223. CrossRef
Benign GI diease,Benign diesease & IBD,Postoperative outcome & ERAS,Minimally invasive surgery
- Comparing the Postoperative Outcomes of Single-Incision Laparoscopic Appendectomy and Three Port Appendectomy With Enhanced Recovery After Surgery Protocol for Acute Appendicitis: A Propensity Score Matching Analysis
-
Won Jong Kim, Hyeong Yong Jin, Hyojin Lee, Jung Hoon Bae, Wooree Koh, Ji Yeon Mun, Hee Ju Kim, In Kyu Lee, Yoon Suk Lee, Chul Seung Lee
-
Ann Coloproctol. 2021;37(4):232-238. Published online September 30, 2020
-
DOI: https://doi.org/10.3393/ac.2020.09.15
-
-
4,851
View
-
109
Download
-
14
Web of Science
-
19
Citations
-
Abstract
PDF
- Purpose
The objective of this study was to compare the perioperative outcomes between single-incision laparoscopic appendectomy (SILA) and 3-port conventional laparoscopic appendectomy (CLA) in enhanced recovery after surgery (ERAS) protocol.
Methods
Of 101 laparoscopic appendectomy with ERAS protocol cases for appendicitis from March 2019 to April 2020, 54 patients underwent SILA with multimodal analgesic approach (group 1) while 47 patients received CLA with multimodal analgesic approach (group 2). SILA and CLA were compared with the single institution’s ERAS protocol. To adjust for baseline differences and selection bias, operative outcomes and complications were compared after propensity score matching (PSM).
Results
After 1:1 PSM, well-matched 35 patients in each group were evaluated. Postoperative hospital stays for patients in group 1 (1.2 ± 0.8 vs. 1.6 ± 0.8 days, P = 0.037) were significantly lesser than those for patients in group 2. However, opioid consumption (2.0 mg vs. 1.4 mg, P=0.1) and the postoperative scores of visual analogue scale for pain at 6 hours (2.4±1.9 vs. 2.8 ± 1.4, P = 0.260) and 12 hours (2.4 ± 2.0 vs. 2.9 ± 1.5, P = 0.257) did not show significant difference between the 2 groups.
Conclusion
SILA resulted in shortening the length of hospitalization without increase in complications or readmission rates compared to CLA with ERAS protocol.
-
Citations
Citations to this article as recorded by

- Perioperative outcomes of laparoscopic low anterior resection using ArtiSential® versus robotic approach in patients with rectal cancer: a propensity score matching analysis
I. K. Kim, C. S. Lee, J. H. Bae, S. R. Han, W. Alshalawi, B. C. Kim, I. K. Lee, D. S. Lee, Y. S. Lee
Techniques in Coloproctology.2024;[Epub] CrossRef - Challenging issues of implementing enhanced recovery after surgery programs in South Korea
Soo-Hyuk Yoon, Ho-Jin Lee
Anesthesia and Pain Medicine.2024; 19(1): 24. CrossRef - A Single Site Approach to Appendicitis: A Review of a Single Center
Yoshito Tsuji, Yujiro Nishizawa, Yuki Ozato, Akira Inoue, Yoshinori Kagawa
Nippon Daicho Komonbyo Gakkai Zasshi.2024; 77(3): 161. CrossRef - The “Hansol-roll” folding method for placement of self-gripping (ProGrip™) mesh in single-port inguinal hernia repair using ArtiSential®
Gwan Chul Lee, Dong Woo Kang, Choon Sik Chung, Chul Seung Lee
Asian Journal of Surgery.2024; 47(7): 3272. CrossRef - Comparison between liquid skin adhesive and wound closure strip for skin closure after subcuticular suturing in single-port laparoscopic appendectomy: a single-center retrospective study in Korea
Kyeong Eui Kim, Yu Ra Jeon, Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek
Journal of Minimally Invasive Surgery.2024; 27(1): 14. CrossRef - Progress in Clinical Treatment of Uncomplicated Acute Appendicitis in Children
珊 白
Advances in Clinical Medicine.2024; 14(04): 471. CrossRef - Single-incision laparoscopic total extraperitoneal inguinal-hernia repair using the new articulating instruments: A video vignette
Chul Seung Lee, Gwan Chul Lee, Choon Sik Chung, Dong Keun Lee
Asian Journal of Surgery.2024; 47(8): 3586. CrossRef - Single-incision versus conventional multi-incision laparoscopic appendicectomy for suspected uncomplicated appendicitis
Ahmer Irfan, Ahsan Rao, Irfan Ahmed
Cochrane Database of Systematic Reviews.2024;[Epub] CrossRef - Clinical Outcomes of Single-incision Laparoscopic Appendectomy Versus Conventional Laparoscopic Appendectomy in Adult Acute Appendicitis
SHINTARO KOHAMA, KUNIHIKO NAGAKARI, MASAKAZU OHUCHI, KAZUHIRO TAKEHARA, KUMPEI HONJO, SHUN ISHIYAMA, KIICHI SUGIMOTO, SHINICHI OKA, JIRO YOSHIMOTO, MASAKI FUKUNAGA, YOICHI ISHIZAKI, KAZUHIRO SAKAMOTO
Juntendo Medical Journal.2024; 70(6): 436. CrossRef - Risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis
Jiyoung Shin, Myong Hoon Ihn, Kyung Sik Kim, Sang Hyun Kim, Jihyoun Lee, Sangchul Yun, Sung Woo Cho
Annals of Coloproctology.2023; 39(1): 50. CrossRef - A prospective randomized controlled study comparing patient-reported scar evaluation of single-port versus multiport laparoscopic appendectomy for acute appendicitis
Kyeong Eui Kim, In Soo Cho, Sung Uk Bae, Woon Kyung Jeong, Hyung Jin Kim, Seong Kyu Baek
Journal of Minimally Invasive Surgery.2023; 26(2): 55. CrossRef - The Latest Results and Future Directions of Research for Enhanced Recovery after Surgery in the Field of Colorectal Surgery
Min Ki Kim
The Ewha Medical Journal.2023;[Epub] CrossRef - Analyzing the conversion factors associated with switching from a single-incision, one-puncture procedure to a two-site, three-port procedure in pediatric laparoscopic appendectomy
Keisuke Yano, Mitsuru Muto, Toshio Harumatsu, Taichiro Nagai, Masakazu Murakami, Chihiro Kedoin, Ayaka Nagano, Mayu Matsui, Koshiro Sugita, Shun Onishi, Koji Yamada, Waka Yamada, Makoto Matsukubo, Tatsuru Kaji, Satoshi Ieiri
Journal of Pediatric Endoscopic Surgery.2022; 4(2): 49. CrossRef - Laparoscopic Appendectomy Using the Surgical-Glove Port Through an Umbilical Incision: A Single-Center Retrospective Study
Tran Que Son, Tran Hieu Hoc, Vu Duc Long, Tran Thanh Tung, Nguyen Minh Tuan, Bui Minh Hue, Nguyen Van Minh, Nguyen Toan Thang
Cureus.2022;[Epub] CrossRef - Single-port robotic totally extraperitoneal(TEP) inguinal hernia repair using the da Vinci SP platform: A video vignette
Dongjun Kim, Chul Seung Lee
Asian Journal of Surgery.2022; 45(10): 2062. CrossRef - Single-incision compared with conventional laparoscopy for appendectomy in acute appendicitis: a systematic review and meta-analysis
Changjia Li, Yukun Liu, Yumin Jiang, Yongjing Xu, Zhiwei Wang
International Journal of Colorectal Disease.2022; 37(9): 1925. CrossRef - Enhanced recovery after surgery pathways for patients undergoing laparoscopic appendectomy
Abhijit Nair, Hamed Humayid Mohammed Al-Aamri, Osama Azmy Ishaq, Parwez Waseemul Haque
Journal of Acute Disease.2022; 11(5): 173. CrossRef - Robot-Assisted Colorectal Surgery
Young Il Kim
The Ewha Medical Journal.2022;[Epub] CrossRef - Enhanced recovery after surgery: importance of compliance audits
Jung Hoon Bae
Journal of the Korean Medical Association.2021; 64(12): 820. CrossRef
Benign GI diease, Functional outcomes
- The Effects of Preoperative Pain Education on the Decision to Discharge Patients Following Single-Incision Laparoscopic Appendectomy
-
Ji Won Seo, Moon Jin Kim, Sung-Hoon Yoon, Kwang Yeol Paik, Sun Min Park, Won Kyung Kang, Dosang Lee, Chul Seung Lee
-
Ann Coloproctol. 2020;36(6):398-402. Published online January 24, 2020
-
DOI: https://doi.org/10.3393/ac.2020.01.16
-
-
4,331
View
-
165
Download
-
7
Web of Science
-
7
Citations
-
Abstract
PDF
Supplementary Material
- Purpose
Few studies have analyzed the effects of preoperative pain education on the postoperative decision to discharge. The purpose of this study was to determine the effects of pain education and management on the decision to discharge patients after single-incision laparoscopic appendectomy (SILA).
Methods
We analyzed 135 patients who had undergone SILA for acute appendicitis between March 2017 and April 2018 in a single medical center. Of these, 72 patients (53.3%) had received preoperative pain education (group 1), and 63 (46.7%) had not (group 2). We compared perioperative outcomes and complications between the groups.
Results
Baseline characteristics of sex, age, body mass index, American Society of Anesthesiologist score, and systemic inflammation factors (neutrophil-lymphocyte ratio, C-reactive protein level) did not differ significantly between the groups. There were no postoperative complications for patients in either group. Perioperative consequences and pathologic findings were not significantly different between the groups; however, length of hospital was significantly shorter in group 1.
Conclusion
Preoperative pain education in relation to postoperative pain management influenced the decision to shorten the postoperative hospital length of stay after SILA.
-
Citations
Citations to this article as recorded by

- Perioperative outcomes of laparoscopic low anterior resection using ArtiSential® versus robotic approach in patients with rectal cancer: a propensity score matching analysis
I. K. Kim, C. S. Lee, J. H. Bae, S. R. Han, W. Alshalawi, B. C. Kim, I. K. Lee, D. S. Lee, Y. S. Lee
Techniques in Coloproctology.2024;[Epub] CrossRef - Effect of continuous wound infiltration on patients using intravenous patient-controlled analgesia for pain management after reduced-port laparoscopic colorectal surgery
Hyeon Deok Choi, Sung Uk Bae
Annals of Coloproctology.2024; 40(6): 564. CrossRef - Relationship Between Appendectomy Incidence and Computed Tomography Scans Based on Korean Nationwide Data, 2003–2017
Ki Bum Park, Jinwook Hong, Jong Youn Moon, Jaehun Jung, Ho Seok Seo
Journal of Korean Medical Science.2022;[Epub] CrossRef - Wound Irrigation Using Wet Gauze May Reduce Surgical Site Infection Following Laparoscopic Appendectomy
Abdullah Al-Sawat, Ji Yeon Mun, Sung Hoon Yoon, Chul Seung Lee
Frontiers in Surgery.2022;[Epub] CrossRef - Surgical rectus sheath block combined with multimodal pain management reduces postoperative pain and analgesic requirement after single-incision laparoscopic appendectomy: a retrospective study
Won Jong Kim, Ji Yeon Mun, Hee Ju Kim, Sung-Hoon Yoon, Seung-Rim Han, Jung Hoon Bae, In Kyu Lee, Yoon Suk Lee, Do Sang Lee, Chul Seung Lee
International Journal of Colorectal Disease.2021; 36(1): 75. CrossRef - Clinical effect of multimodal perioperative pain management protocol for minimally invasive colorectal cancer surgery: Propensity score matching study
Chul Seung Lee, Soo Ji Park, Sang Hyun Hong, Jung-Woo Shim, Min Suk Chae, Seung-Rim Han, Jung Hoon Bae, In Kyu Lee, Dosang Lee, Yoon Suk Lee, Seong Taek Oh
Asian Journal of Surgery.2021; 44(2): 471. CrossRef - Comparing the Postoperative Outcomes of Single-Incision Laparoscopic Appendectomy and Three Port Appendectomy With Enhanced Recovery After Surgery Protocol for Acute Appendicitis: A Propensity Score Matching Analysis
Won Jong Kim, Hyeong Yong Jin, Hyojin Lee, Jung Hoon Bae, Wooree Koh, Ji Yeon Mun, Hee Ju Kim, In Kyu Lee, Yoon Suk Lee, Chul Seung Lee
Annals of Coloproctology.2021; 37(4): 232. CrossRef