Essential Elements for Enhanced Recovery After Intra-abdominal Surgery

Enhanced recovery pathways provide a framework outlining the best perioperative care for intra-abdominal surgical procedures. To date, no evidence-based umbrella guidelines exist for all intra-abdominal surgeries.

A PubMed and worldwide web search was performed with the keywords: "ERAS," "enhanced recovery after surgery", ± "protocol." Manuscripts addressing intra-abdominal procedures were selected, resulting in studies with the date range: 2012-2017. The basic philosophy behind enhanced recovery is the realization that a traditional hospital works in silos that need to be broken to ensure a care protocol that follows and optimizes the journey the patient makes during the perioperative care. Enhanced recovery interventions can be categorized into preoperative, perioperative, and postoperative interventions. By design, each intervention is planned and coordinated by a multidisciplinary ERAS team. Depending on the particular procedure and patient receiving the interventions, some of the interventions below may be more or less applicable. In this review, the most common elements of ERAS protocols in intra-abdominal procedures are reviewed, particularly those which provided the best outcomes and are most generalizable to all intra-abdominal procedures.