The ERAS protocol
ERAS (Enhanced Recovery After Surgery) is a modern, evidence-based protocol that optimizes patient preparation, surgery and recovery. Applying ERAS in rectal surgery has been shown to reduce hospital stay, complications and improve patient comfort.
Before admission
Preoperative assessment
- Anesthesia consultation — assessing anesthetic risk and optimizing medical conditions
- Blood tests — complete blood count, coagulation, liver and kidney function
- ECG and chest X-ray — assessing cardiac and pulmonary function
- Optimization of chronic treatments — adjusting existing medications
Physical condition
- Prehabilitation — moderate physical exercise (walking, cycling) for 2-4 weeks before surgery
- Smoking cessation — ideally at least 4 weeks before
- Reducing alcohol consumption
- Breathing exercises — to prevent pulmonary complications
Preoperative nutrition
- Nutritional status assessment — identifying and correcting malnutrition
- Nutritional supplements — if needed, prescribed by a doctor
- Mechanical bowel preparation is not always necessary (per ERAS)
- Carbohydrate loading — a carbohydrate drink 2 hours before surgery (reduces insulin resistance)
Day of surgery
- Short fasting — clear liquids until 2 hours before anesthesia, solid food until 6 hours before
- Antithrombotic prophylaxis — low-molecular-weight heparin + compression stockings
- Antibiotic prophylaxis — single dose given at anesthesia induction
- Hypothermia prevention — active warming of the patient during surgery
If you will have a stoma
If the surgical plan includes creating a stoma (temporary or permanent):
- Consultation with a stoma nurse specialist before surgery
- Marking the stoma site on the abdomen — in an optimal position, visible to the patient, avoiding skin folds
- Preoperative education about stoma care
- Psychological support — adjusting to the idea of having a stoma
Fertility and family planning
Colorectal cancer is being diagnosed more frequently in young adults. Treatment for rectal cancer, especially radiotherapy, may affect the ability to have children.
- Radiotherapy may affect the ovaries and testes, causing them to stop producing the hormones needed for natural pregnancy
- Chemotherapy may also affect fertility by damaging sperm or eggs
If you wish to have children after treatment or are unsure, discuss with the medical team before starting treatment about fertility preservation options:
Options for men
- Sperm banking — sperm is collected and frozen in liquid nitrogen for later use (semen cryopreservation)
Options for women
- Egg freezing — eggs are extracted, frozen and stored for later use (oocyte cryopreservation)
- Ovarian tissue banking — removal and freezing of part of the ovary containing eggs, for later reimplantation
- Ovarian transposition (oophoropexy) — a procedure that moves one or both ovaries out of the radiation field
Important: These discussions must be held before any treatment begins. Once radiotherapy or chemotherapy has started, the options are significantly reduced.
What to bring to the hospital
- ID and medical documents
- Comfortable clothes, closed slippers for walking in the corridor
- Personal hygiene items
- A list of medications you take
- Questions for the medical team (see the Questions for Your Doctor page)
Realistic expectations
Discuss with your surgeon before surgery about:
- The type of operation planned and possible alternatives
- The risk of a stoma — temporary or permanent
- The estimated hospital stay
- Postoperative restrictions and the recovery plan
- Possible complications and how they are managed