About the book
The surgical global carefulness and charge require not only the training in the basic sciences, the knowledge of pathology, the application of technical skills, and the management of diagnostic and therapeutic problems. The surgical activity should be completed by a deep understanding of the patient and the commitment to ensure a rapid return to normal after surgical treatment. The surgeon’s initial contact with the patient is important. That is the opportunity to gain the patient’s confidence and convey the assurance that the therapeutic procedure is available and effective. The surgeon needs to demonstrate concern and commitment for the patient as a person who requires care and not just a “case” to be treated by surgical therapy. Today we must believe that the rapid and safe recovery after surgical therapy is a fundamental feature alongside the results of resolution/control of the pathology. The first revolutionary step in this perspective has been taken, and for thirty years it has continued and evolved universally, through the introduction of minimally invasive therapeutic approaches. The pathway of control and improvement of perioperative care have had great diffusion, in the last years, in the current practice of surgical wards. The perioperative procedure scheme that applies the principle of a safe and rapid postoperative recovery is standardized in the system unanimously called Enhanced Recovery After Surgery (ERAS). The basic characteristics of the procedure are the enterprise to improve surgical quality, the choice of innovative management and therapeutic procedures, but always based on evidence, and finally the multidisciplinarity that involves medical skills from various medical specialties in the management of treatments. Therefore all surgical specialties are involved in what we can define as a cultural movement in medical practice. The particular aspects of improving recovery following surgical procedures are summarized in the following actions: to support patient mobilization, decrease complication rates after surgery, shorten the length of hospital stay and reduce costs. The components of enhanced recovery after surgery are varied and numerous and can be divided in detail into the pre, intra, and postoperative phases. Among other elements are included: smoking and alcohol use stopped some weeks and nutritional assessment before surgery, intraoperative use of antibiotics, postoperative multimodal analgesia and nausea control, active and early mobilization, early feeding, reduce as much as possible the use of the nasogastric tube and abdominal drains, early removal of a urinary catheter. Finally, two propositions are in evidence. a multidisciplinary medical team should be implicated in achieving the accomplishment of an ERAS pathway; moreover, the main purposes of ERAS are to reduce the surgical stress and to preserve, how is it possible, the physiological conditions, consequently these therapeutic choices should, in principle. be employed routine, currently in surgery.