During the last decade Fast-track or Enhanced Recovery packages have shown rapid evolution and widespread introduction to colorectal units throughout Europe and the United States of America. The 'fast-track' approach prescribes a 'multi-modal' and 'multi-disciplinary' package of care to guide the pre-operative, peri-operative and post-operative management of surgical patients. By using these care protocols fast-track surgery aims to optimise patient's post-operative recovery through reducing the physiological stress response evoked by surgery and enabling quicker physiological recovery thus allowing early return to normal function and discharge. Furthermore, it is believed that psychological and physical benefits arise through the application of fast-track packages which also act to promote patients recovery. A detailed review examining the evidence for each individual element of the fast-track packages was undertaken. It demonstrated the range in availability and quality of evidence available to guide application of modern clinical management. Currently fast-track enthusiasts still rely on data from observational studies and controlled clinical trials to justify their use of this approach, as a few, small, single-centred and low-numbered randomised controlled trials exist in this field.