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Comparison of Enhanced Recovery After Surgery (ERAS) Pathway Versus Standard Care in Patients Undergoing Elective Stoma Reversal Surgery- A Randomized Controlled Trial

  • SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Practices such as prolonged preoperative fasting, bowel preparation, delayed ambulation and resumption of orals result in morbidity in 15-20% of stoma reversal cases which can be improved by Enhanced Recovery After Surgery (ERAS) pathways.

Aim

To evaluate the safety, feasibility and efficacy of ERAS pathway in patients undergoing elective loop ileostomy or colostomy reversal surgery

Methods

This was an open-labeled, superiority randomized controlled trial in which patients undergoing loop ileostomy or colostomy reversal were randomized to standard or ERAS care. Patients with ASA class ≥3, needing laparotomy for stoma reversal, cardiac, renal and neurological illnesses were excluded. Components of ERAS protocol included pre-operative carbohydrate loading, avoidance of mechanical bowel preparation, goal directed fluid therapy, avoidance of long-acting opioid anesthetics or analgesics, avoidance of drains, urinary catheter or nasogastric tube, early mobilization and early enteral feeding. The primary outcome was length of stay (LOS) while the secondary outcomes were postoperative recovery and morbidity parameters.

Results

Forty patients each were randomized to standard care and ERAS. Demographic and laboratory parameters between the two groups were comparable. ERAS group patients had significantly reduced LOS (5.3 ± 0.3 vs 7 ± 2.6; mean difference: 1.73 ± 0.98; p=0.0008). Functional recovery was earlier in the ERAS group compared to the standard care group, such as early resolution of ileus (median-2 days; p<0.001), time to first stool (median-3 days; p=0.0002), time to the resumption of liquid diet (median-3 days; p<0.001) and solid diet (median-4 days; p<0.001). Surgical site infections (SSI) were significantly lesser in ERAS group (12.5% vs 32.5%; p=0.03) while postoperative nausea/vomiting (p=0.08), pulmonary complications (p=0.17) and urinary tract infections (p=0.56) were comparable in both groups.

Conclusion

ERAS pathways are feasible, safe and significantly reduces LOS in patients undergoing elective loop ileostomy or colostomy reversal surgery.

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Acknowledgments

The authors acknowledge the support of Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER, Pondicherry, India) towards the conduct of the study.

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Authors and Affiliations

  1. Departments of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India

    Shivakumar Madan, Sathasivam Sureshkumar, Amaranathan Anandhi, Andi Rajendharan Keerthi & Vikram Kate

  2. Cancer Institute Womens’ Indian Association (WIA), Chennai, India

    Balakrishnan Gurushankari

  3. Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India

    Chinnakali Palanivel

  4. Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India

    Pankaj Kundra

Authors
  1. Shivakumar Madan
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  2. Sathasivam Sureshkumar
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  3. Amaranathan Anandhi
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  4. Balakrishnan Gurushankari
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  6. Chinnakali Palanivel
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  8. Vikram Kate
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Contributions

S Madan – Data collection/management, manuscript writing/editing.

S Sureshkumar – Protocol/project development, manuscript writing/editing.

A Anandhi - Data management, Manuscript writing/editing.

B Gurushankari - Data management, Manuscript writing/editing.

AR Keerthi – Data management, Manuscript writing/editing.

C Palanivel – Data analysis

P Kundra – Protocol/project development, manuscript writing/editing.

V Kate – Protocol/project development, data management, data analysis and manuscript writing/editing.

Corresponding author

Correspondence to Vikram Kate.

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Madan, S., Sureshkumar, S., Anandhi, A. et al. Comparison of Enhanced Recovery After Surgery (ERAS) Pathway Versus Standard Care in Patients Undergoing Elective Stoma Reversal Surgery- A Randomized Controlled Trial. J Gastrointest Surg 27, 2667–2675 (2023). https://doi.org/10.1007/s11605-023-05803-9

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