Effect of Enhanced Recovery After Surgery on Laparoscopic Appendectomy Outcomes in Patients with Complicated Appendicitis: a Randomized Controlled Trial



The implementation of enhanced recovery after surgery (ERAS) pathway has resulted in shorter length of stay (LOS), fewer complications, and lowering of medical costs. We aimed to investigate if ERAS protocol implementation in patients with complicated appendicitis reduces the LOS after laparoscopic appendectomy.


In this randomized controlled trial, 38 patients were randomly assigned to laparoscopic appendectomy with ERAS protocol (LE) or with conventional care (LC). The primary outcome was the hospital LOS. The secondary outcomes included time to resume diet, postoperative complications, readmissions, and reoperation rates.


From April 2019 to December 2019, 19 patients in the LE group and 19 in the LC were included. There were no significant differences in preoperative data. Regarding the primary outcome of the study, the ERAS protocol did not significantly reduce the postoperative LOS in comparison with conventional care (63.8 ± 62.10 h vs. 95.3 ± 135.78 h, p=0.366). There was a significant reduction in time to resume diet (367.3 vs. 696.3 min, p=0.003). We did not find differences in terms of postoperative complications, pain control, readmission, and reoperation rates.


Laparoscopic appendectomy with ERAS protocol was not superior to laparoscopic appendectomy with conventional care for the treatment of complicated appendicitis in terms of hospital LOS. However, postoperative morbidity, readmission, and reoperation rates were similar in both groups, making ERAS implementation a safe and feasible alternative to conventional care.

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We would like to thank Dr. Judith Rodriguez for the supervision and corrections to the protocol.

Author information




ANV, MTA, and ECL were involved in study conception and design. ANV did data acquisition. ECL and MTA performed statistical analyses, drafted the manuscript, contributed to study concept, critically revised the manuscript, performed overall supervision, and contributed to the final approval of the manuscript. CVS, JHE, and MMP interpreted the data, drafted the manuscript, critically revised the manuscript, and contributed to the final approval of the manuscript.

Corresponding author

Correspondence to Mario Trejo-Avila.

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Ethics Approval and Consent to Participate

All procedures were performed in accordance with the ethical standards of the institutional research committee. The present study was approved by the institutional research and ethical board of our hospital (Registration Number: 04-18-2019).

Informed Consent

Informed consent for participation was obtained from all patients included in the study.

Conflict of Interest

The authors declare no competing interests.

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Núñez-Venzor, A., Trejo-Avila, M., Cárdenas-Lailson, E. et al. Effect of Enhanced Recovery After Surgery on Laparoscopic Appendectomy Outcomes in Patients with Complicated Appendicitis: a Randomized Controlled Trial. SN Compr. Clin. Med. 3, 646–653 (2021). https://doi.org/10.1007/s42399-021-00788-5

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  • Acute appendicitis
  • Complicated appendicitis
  • Enhanced recovery after surgery
  • Laparoscopic appendectomy