The philosophy of this approach is to perform more complex interventions with minimal insult and a resultant decrease in morbidity. It is a multimodality approach which aims for stress free and pain free surgery.

Preoperative period: Traditionally, patients having bowel surgery used to be starved before the operation and were given strong bowel prep to clean their bowels. As a result, by the time the patients were in a state of negative energy when they came in for the operation. The enhanced recovery programme represents a complete chance in this approach. Patients are given high carbohydrate drinks preoperatively to build them up, they are educated about the entire process, and in most cases, bowel preparation is not used.

Operative period: At operation, emphasis is given to minimally invasive surgery. If laproscopic surgery is not possible for whatever reason, preference is given to transverse cuts on the belly, which result in less pain than vertical cuts, which go through the distribution of more than one nerve.

Postoperative period: In the postoperative period, the three pillars of management include the early introduction of oral feeding, good pain relief and early mobilisation. This is in complete contrast to traditional teaching, when patients were kept starving until they passed wind and opened their bowels, and were recommended bed rest for recovery.

• Preoperative patient education
• Preoperative nutritional supplements
• No bowel preparation
• Minimally invasive surgery
• Postoperative pain relief (Epidural anaesthesia)
• Early nutrition postoperatively
• Early mobilisation postoperatively

Mr Prabhudesai is actively involved in the Enhanced Recovery programme for his patients and has found that with the ethos of the Enhanced Recovery Programme, the patients feel involved and well informed about their care, improving overall patient satisfaction.