Efficacy of the ERAS strategy in patients with type III–IV paraesophageal hernias

Abstract

ERAS (Enhanced Recovery After Surgery) protocols have demonstrated efficacy across numerous surgical specialties; however, their effectiveness has not been evaluated in patients with paraesophageal hernias (PEH). Objective — to determine the efficacy of the ERAS strategy in patients with type III—IV PEH undergoing laparoscopic surgery. Materials and methods. The study was conducted at the Department of General Surgery No 2 of Bogomolets National Medical University from 2017 to 2023, involving 114 patients who underwent laparoscopic hernioplasty for Type III—IV PEH. The ERAS strategy was applied in 96 patients (main group — Group M) and not applied in 18 patients (comparison group — Group C). The efficacy of the ERAS protocol was evaluated by comparing average hospital stay, hunger, thirst, general weakness, and depression levels using a 10‑point visual analogue scale (0=«no concern,» 10=«severe concern»), as well as the frequency of nausea, vomiting, abdominal distention, passage of gas, and bowel movement within the first postoperative day. Results. Group M showed lower average scores for «general weakness», «hunger», and «thirst» by factors of 1.43, 1.35, and 1.34, respectively, compared to Group C. The application of the ERAS protocol positively influenced bowel function recovery: on the first postoperative day, the proportion of patients with gas passage was higher in Group M than in Group C (78.1% vs. 55.6%), while the incidence of abdominal distention was lower (2.1% vs. 16.7%). Bowel movement was observed in 51.0% of patients in Group M compared to 27.8% in Group C. These positive outcomes associated with the ERAS protocol contributed to a reduced average hospital stay of 1.72±0.76 days compared to 2.33±0.91 days in the control group. Conclusions. The use of the ERAS protocol in patients undergoing laparoscopic surgery for type III—IV paraesophageal hernia demonstrated significant advantages in the early postoperative period. Patients reported significantly less «general weakness», «feeling of hunger», and «feeling of thirst» compared to the control group. Improved bowel function recovery was recorded, evidenced by a higher proportion of patients with gas passage and bowel movements and a significantly lower proportion of patients with abdominal distension, as well as a reduced average length of hospital stay. The obtained results confirm the feasibility of implementing the ERAS protocol to improve postoperative recovery and reduce postoperative complications in patients with type III—IV paraesophageal hernia.