Enhanced recovery after surgery versus conventional approach in peptic perforation- a Randomized Controlled Trial-...

Implementing Enhanced Recovery After Surgery (ERAS) protocol in elective surgeries has improved outcomes. Evidence for a similar role in emergency surgeries must be explored, particularly in patients with peptic perforation. This research aims to study the safety and efficacy of ERAS in patients undergoing surgery for peptic perforation peritonitis.

Our study was an open-labeled, randomized, controlled superiority trial conducted on 60 patients of peptic perforation, restricted to first and second category of ASA and distributed equally between the Conventional and ERAS arms. The key interventions in the ERAS arm were intraoperative rectus sheath blockade, encouraging early ambulation, early removal of indwelling catheters and tubes, and early initiation of oral fluid and solid diet.

The median length of hospital stay was significantly shorter in the ERAS arm (3 vs 5 days). The patients in the ERAS group were free from all the indwelling catheters within 24 h of the surgery. The time to ambulate (21 h vs 48 h) and initiation of unrestricted clear liquids (after 6 h of surgery) was significantly quicker in the ERAS arm. The surgical site infection (10 vs 5) and pneumonia (5 vs 1) rates were higher in the conventional group. This was clinically significant, even though it failed to attain statistical significance. The comprehensive complication index was significantly higher in the conventional arm. In this study, there was 100% compliance with seven out of eight ERAS interventions.

The ERAS protocol helped shorten the time needed to attain the preoperative physiological parameters, including bowel functions and reduced the LOHS in patients operated for peptic perforation.