Table 2 Difference between ERAS and modified ERAS

Preoperative fasting

Carbohydrate loading 2 h before surgery

Fasting 6 h before surgery (according to anesthesia), carbohydrate loading 4 h before surgery (water with glucose 400 mg or clear juice like apples juice)

Thrombosis prophylaxis

Heparin 5000u given before incision

Consultation with hemato-oncology division for the evaluation of LMWH heparin for the prevention of DVT

Analgesia

Goal is to avoid IV opioids. Postoperative analgesia including thoracic epidural analgesia

NSAID intravenous analgesia postoperative such as ketorolac for 3 days and continue with oral paracetamol 500 mg every 6 to 8 h

Postoperative diet

Oral nutrition started 4 h after surgery

Oral intake can be started 12 h after surgery

Preventing PONV

Multimodal PONV prophylaxis in all patients

Give metoclopramide if needed

pelvic drainage

Omission of the use of perianastomotic and/or pelvic drain

Use of perianastomotic and pelvic drainage

Minimally invasive approach

Use of laparoscopic/robotic technique

We still using open surgery in several cases,