Role of integrating prehabilitation with the Enhanced Recovery After Surgery (ERAS) protocol in Hartmann’s procedure

Abstract

Presentation
A seventy-year-old woman with significant comorbidities presented with a three-month history of bowel movements from her Hartmann’s procedure (HP) rectal stump, which was performed years earlier, despite having a colostomy.

Diagnosis
An abdominal computed tomography (CT) scan revealed a fistula from the ileocecal region to the rectal stump.

Treatment
Due to anticipated poor surgical results from comorbidities, an endoscopic over-the-scope clip (OTSC) was applied to the ileocecal fistula. This procedure failed, necessitating a total colectomy and end ileostomy. The patient encountered complications from pre-existing conditions post-surgery and ultimately passed away from these health issues.

Discussion
HP involves significant risks, including mortality. The Enhanced Recovery After Surgery (ERAS) guidelines aim to reduce postoperative complications through a multidisciplinary approach. However, they lack measures to enhance overall functional capacity, including cardiopulmonary efficiency and muscle strengthening. Incorporating prehabilitation strategies into the ERAS protocol is crucial for improving outcomes for less fit patients.