Skip to main content
SpringerLink
Log in

Intra- and post-operative outcomes of the Enhanced Recovery after Surgery (ERAS) Program in laparoscopic hysterectomy

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To investigate the effect of the Enhanced Recovery After Surgery (ERAS) protocol on perioperative and post-operative outcomes in laparoscopic hysterectomies (LHs) performed for benign gynecological diseases.

Methods

This prospective study was conducted with randomized 100 participants who underwent LH between 1 January and 31 December, 2022. A standard care protocol was applied to 50 participants (Group 1, control) and the ERAS protocol to the other 50 (Group 2, study). Length of hospitalization was compared between the groups as the primary outcome, and the duration of the operation, the amount of bleeding, post-operative nausea-vomiting, gas discharge time, visual analog scale (VAS) pain scores, and complications as the secondary outcomes.

Results

No statistically significant difference was seen between the groups in terms of sociodemographic characteristics, medical history, operation indications, surgical procedures applied in addition to hysterectomy, operative time, pre-operative and post-operative hemoglobin levels, amount of bleeding, or drain use (p > 0.05). However, a statistically significant difference was observed in terms of nausea (60% vs. 26%, p = 0.001), vomiting (28% vs. 10%, p = 0.040), duration of gassing (17.74 ± 6.77 vs. 14.20 ± 7.05 h, p = 0.012), length of hospitalization (41.78 ± 12.17 vs. 34.12 ± 10.90 h, p = 0.001), analgesic requirements (4.62 ± 1.36 vs. 3.34 ± 1.27 h, p < 0.001), or VAS scores at the 1st (5.86 ± 1.21 vs. 4.58 ± 1.31, p < 0.001), 6th (5.16 ± 1.12 vs. 4.04 ± 1.08, p < 0.001), 12th (4.72 ± 1.12 vs. 3.48 ± 1.12, p < 0.001), 18th (4.48 ± 1.21 vs. 3.24 ± 1.34, p < 0.001), and 24th (4.08 ± 1.29 vs. 3.01 ± 1.30, p < 0.001) hours.

Conclusion

The findings of this study show that the ERAS protocol has a positive effect on peri- and post-operative outcomes in LH. Further prospective studies are now needed to confirm the validity of the results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

Data is available with the permission of the corresponding author corresponding email: dr.hasanaliinal@yahoo.com.

References

  1. Inal ZO, Inal HA (2018) Comparison of abdominal, vaginal, and laparoscopic hysterectomies in a tertiary care hospital in Turkey. Ir J Med Sci 187:485–491

    Article  CAS  PubMed  Google Scholar 

  2. Schmitt JJ, Carranza Leon DA, Occhino JA, Weaver AL, Dowdy SC, Bakkum-Gamez JN et al (2017) Determining optimal route of hysterectomy for benign indications: clinical decision tree algorithm. Obstet Gynecol 129:130–138

    Article  PubMed  PubMed Central  Google Scholar 

  3. Hur HC, Donnellan N, Mansuria S, Barber RE, Guido R, Lee T (2011) Vaginal cuff dehiscence after different modes of hysterectomy. Obstet Gynecol 118:794–801

    Article  PubMed  Google Scholar 

  4. What is ERAS? [Internet]. Available from: https://eras.org.tr/page.php?id=9. Accessed 6 Jul 2022

  5. Joshi GP, Kehlet H (2019) Postoperative pain management in the era of ERAS: an overview. Best Pract Res Clin Anaesthesiol 33:259–267

    Article  PubMed  Google Scholar 

  6. Mulayim B, Karadag B (2018) Do we need mechanical bowel preparation before benign gynecologic laparoscopic surgeries: a randomized, single-blind, controlled trial. Gynecol Obstet Invest 83:203–208

    Article  CAS  PubMed  Google Scholar 

  7. Uyanıklar ÖÖ, Türk P, Aslan K, Aslan EK, Özden O, Gürlüer J et al (2023) How does the ERAS protocol work in patients who underwent cesarean section? HERMES study. Int J Gynaecol Obstet 161:168–174

    Article  PubMed  Google Scholar 

  8. Yilmaz G, Akca A, Kiyak H, Salihoglu Z (2020) Comparison of enhanced recovery protocol with conventional care in patients undergoing minor gynecologic surgery. Wideochir Inne Tech Maloinwazyjne 15:220–226

    PubMed  Google Scholar 

  9. Ozturk Inal Z, Gorkem U, Inal HA (2020) Effects of preoperative anxiety on postcesarean delivery pain and analgesic consumption: general versus spinal anesthesia. J Matern Fetal Neonatal Med 33:191–197

    Article  CAS  PubMed  Google Scholar 

  10. Luchristt D, Brown O, Kenton K, Bretschneider CE (2021) Trends in operative time and outcomes in minimally invasive hysterectomy from 2008 to 2018. Am J Obstet Gynecol 224:202.e1-202.e12

    Article  PubMed  Google Scholar 

  11. Ljungqvist O, Scott M, Fearon KC (2017) Enhanced recovery after surgery: a review. JAMA Surg 152:292–298

    Article  PubMed  Google Scholar 

  12. Cao F, Li J, Li F (2012) Mechanical bowel preparation for elective colorectal surgery: updated systematic review and meta-analysis. Int J Colorectal Dis 27:803–810

    Article  CAS  PubMed  Google Scholar 

  13. Dahabreh IJ, Steele DW, Shah N, Trikalinos TA (2015) Oral mechanical bowel preparation for colorectal surgery: systematic review and meta-analysis. Dis Colon Rectum 58:698–707

    Article  PubMed  Google Scholar 

  14. Nelson G, Bakkum-Gamez J, Kalogera E, Glaser G, Altman A, Meyer LA et al (2019) Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations-2019 update. Int J Gynecol Cancer 29:651–668

    Article  PubMed  Google Scholar 

  15. Minig L, Biffi R, Zanagnolo V, Attanasio A, Beltrami C, Bocciolone L et al (2009) Early oral versus “traditional” postoperative feeding in gynecologic oncology patients undergoing intestinal resection: a randomized controlled trial. Ann Surg Oncol 16:1660–1668

    Article  CAS  PubMed  Google Scholar 

  16. Miller TE, Thacker JK, White WD, Mantyh C, Migaly J, Jin J et al (2014) Enhanced Recovery Study Group. Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol. Anesth Analg 118:1052–1061

    Article  PubMed  Google Scholar 

  17. Rollins KE, Lobo DN (2016) Intraoperative goal-directed fluid therapy in elective major abdominal surgery: a meta-analysis of randomized controlled trials. Ann Surg 263:465–476

    Article  PubMed  Google Scholar 

  18. Smith MD, McCall J, Plank L, Herbison GP, Soop M, Nygren J (2014) Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database Syst Rev (8):CD009161

  19. Park SH, Choi MS (2018) Meta-analysis of the effect of gum chewing after gynecologic surgery. J Obstet Gynecol Neonatal Nurs 47:362–370

    Article  PubMed  Google Scholar 

  20. Darouiche RO, Wall MJ Jr, Itani KM, Otterson MF, Webb AL, Carrick MM et al (2010) Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 362:18–26

    Article  CAS  PubMed  Google Scholar 

  21. Ajuzieogu OV, Amucheazi AO, Nwagha UI, Ezike HA, Luka SK, Abam DS (2016) Effect of routine preoperative fasting on residual gastric volume and acid in patients undergoing myomectomy. Niger J Clin Pract 19:816–820

    Article  CAS  PubMed  Google Scholar 

  22. Yilmaz N, Cekmen N, Bilgin F, Erten E, Ozhan MÖ, Coşar A (2013) Preoperative carbohydrate nutrition reduces postoperative nausea and vomiting compared to preoperative fasting. J Res Med Sci 18:827–832

    PubMed  PubMed Central  Google Scholar 

  23. Kleiman AM, Chisholm CA, Dixon AJ, Sariosek BM, Thiele RH, Hedrick TL et al (2020) Evaluation of the impact of enhanced recovery after surgery protocol implementation on maternal outcomes following elective cesarean delivery. Int J Obstet Anesth 43:39–46

    Article  CAS  PubMed  Google Scholar 

  24. Peng J, Dong R, Jiao J, Liu M, Zhang X, Bu H et al (2021) Enhanced recovery after surgery impact on the systemic inflammatory response of patients following gynecological oncology surgery: a prospective randomized study. Cancer Manag Res 13:4383–4392

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. de Aguilar-Nascimento JE, Leal FS, Dantas DC, Anabuki NT, de Souza AM, Silva E Lima VP et al (2014) Preoperative education in cholecystectomy in the context of a multimodal protocol of perioperative care: a randomized, controlled trial. World J Surg 38:357–362

  26. Katz J, McCartney CJ (2002) Current status of preemptive analgesia. Curr Opin Anaesthesiol 15:435–441

    Article  PubMed  Google Scholar 

  27. Wijk L, Franzen K, Ljungqvist O, Nilsson K (2014) Implementing a structured Enhanced Recovery After Surgery (ERAS) protocol reduces length of stay after abdominal hysterectomy. Acta Obstet Gynecol Scand 93:749–756

    Article  PubMed  Google Scholar 

  28. Yoong W, Sivashanmugarajan V, Relph S, Bell A, Fajemirokun E, Davies T et al (2014) Enhanced Recovery After Surgery (ERAS) Team for Gynaecology and Anaesthesia. Can enhanced recovery pathways improve outcomes of vaginal hysterectomy? Cohort control study. J Minim Invasive Gynecol 21:83–89

    Article  PubMed  Google Scholar 

  29. Kilpiö O, Härkki PSM, Mentula MJ, Väänänen A, Pakarinen PI (2020) Recovery after enhanced versus conventional care laparoscopic hysterectomy performed in the afternoon: a randomized controlled trial. Int J Gynaecol Obstet 151:392–398

    Article  PubMed  Google Scholar 

  30. Inania M, Sharma P, Parikh M (2022) Role of enhanced recovery after surgery in total laparoscopic hysterectomy. J Minim Access Surg 18:186–190

    Article  PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Antalya Training and Research Hospital, Varlık Mh. Kazım Karabekir Cd., 07100, Antalya, Turkey

    Caglar Erkan, Hasan Ali Inal & Aysel Uysal

Authors
  1. Caglar Erkan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hasan Ali Inal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aysel Uysal
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Caglar Erkan and Hasan Ali Inal: Protocol/Project development. Caglar Erkan and Aysel Uysal: Data collection or management. Caglar Erkan, Hasan Ali Inal, and Aysel Uysal: Manuscript writing/editing.

Corresponding author

Correspondence to Hasan Ali Inal.

Ethics declarations

Declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethics committee approval was received for this study from the local ethics committee of the Health Sciences University Antalya Training and Research Hospital (reference no. 2021/294).

Informed consent

Written informed consent was obtained from patients who participated in this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Erkan, C., Inal, H.A. & Uysal, A. Intra- and post-operative outcomes of the Enhanced Recovery after Surgery (ERAS) Program in laparoscopic hysterectomy. Arch Gynecol Obstet (2024). https://doi.org/10.1007/s00404-024-07469-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00404-024-07469-3

Keywords

Search

Navigation