Enhanced Recovery After Surgery (ERAS) vs Standard Care in Peptic Ulcer Perforation: A Systematic Review and...

Peptic ulcer perforation, although infrequently diagnosed, constitutes a severe condition necessitating prompt surgical intervention, regardless of whether conservative or surgical management is pursued. The conventional (standard) postoperative care protocol, characterized by delayed feeding, is typically employed for perioperative management. This study sought to review the existing literature comparing the Enhanced Recovery After Surgery (ERAS) pathway with the standard approach, following both open and laparoscopic Graham's repair for peptic ulcer perforation, in contrast to the traditional method.

A systematic search was conducted in PubMed, Springer, the Cochrane Library, and other resources for studies published over the past 15 years (2011-2026). The selected studies compared the enhanced recovery pathway with the conventional approach for peptic ulcer perforations. A meta-analysis was performed according to the PRISMA guidelines. The risk of bias was assessed using the Newcastle-Ottawa score and funnel plots. Statistical analyses were performed using RevMan version 5.4.

Twelve studies involving 963 patients were included. The meta-analysis demonstrated that patients who underwent enhanced recovery after peptic ulcer perforation surgery exhibited significantly improved clinical outcomes. The length of hospitalization was significantly reduced 0.65[95% CI 0.49, 0.87] p=0.003. The rates of pulmonary complications, venous thromboembolism (0.25 [95% CI 0.14, 0.47], p<0.0001), and superficial and deep surgical site infections (0.47 [95% CI 0.34, 0.66], p<0.0001 and 0.36 [95% CI 0.17, 0.77], p=0.008, respectively) were lower than those in the standard pathway group.

This systematic review and meta-analysis indicate that the enhanced recovery pathway for peptic ulcer perforation is associated with reduced morbidity and shorter hospital stays compared with the standard pathway. Furthermore, perioperative complications in the ERAS group were lower than those in the conventional group.