Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS^®) Society Recommendations Part 2—Emergency Laparotomy: Intra‐ and Postoperative Care

Abstract

Background This is Part 2 of the first consensus guidelines for optimal care of patients undergoing emergency laparotomy (EL) using an Enhanced Recovery After Surgery (ERAS) approach. This paper addresses intra‐ and postoperative aspects of care. Methods Experts in aspects of management of high‐risk and emergency general surgical patients were invited to contribute by the International ERAS® Society. PubMed, Cochrane, Embase, and Medline database searches were performed for ERAS elements and relevant specific topics. Studies on each item were selected with particular attention to randomized clinical trials, systematic reviews, meta‐analyses, and large cohort studies and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Recommendations were made on the best level of evidence, or extrapolation from studies on elective patients when appropriate. A modified Delphi method was used to validate final recommendations. Some ERAS® components covered in other guideline papers are outlined only briefly, with the bulk of the text focusing on key areas pertaining specifically to EL. Results Twenty‐three components of intraoperative and postoperative care were defined. Consensus was reached after three rounds of a modified Delphi Process. Conclusions These guidelines are based on best available evidence for an ERAS® approach to patients undergoing EL. These guidelines are not exhaustive but pull together evidence on important components of care for this high‐risk patient population. As much of the evidence is extrapolated from elective surgery or emergency general surgery (not specifically laparotomy), many of the components need further evaluation in future studies.

Modified Enhanced Recovery After Surgery (ERAS) Protocol Versus Non‐ERAS Protocol in Patients Undergoing Emergency Laparotomy for Acute Intestinal Obstruction: A Randomized Controlled Trial

“…By implementing fast-track protocol, patients in the modified ERAS group had a significant reduction in the time to pass first flatus and stool (p = 0.001 and p = 0.014 respectively). Additionally, liquid and solid diet was tolerated significantly earlier in these patients as also documented in previous studies [13,20,23,37]. In the elective context, the intra-abdominal drain is not routinely placed in the ERAS setting [38].…”

“…Although no difference in the incidence of UTI was seen between the two groups. In fast‐track protocol multimodal analgesia with regional blockade techniques used to alleviate post‐operative pain [37, 39]. In the present study, analgesia was dealt with at every step of ERAS care.…”

Promoting wound recovery through stable intestinal flora: Reducing post‐operative complications in colorectal cancer surgery patients

“…As a result of surgical trauma, anaesthesia and tension, perioperative patients frequently have negative nitrogen balance. Early nutritional support of the intestines in the first few days after surgery is essential for assuring the success of the procedure 20 . Several studies have demonstrated that beginning nutritional support for the intestines as early as possible after surgery can enhance intestinal function recovery and nutritional status.…”

“…Early nutritional support of the intestines in the first few days after surgery is essential for assuring the success of the procedure. 20 Several studies have demonstrated that beginning nutritional support for the intestines as early as possible after surgery can enhance intestinal function recovery and nutritional status. The relationship between intestinal flora and wound recovery following CRC surgery is a subject of growing importance, especially considering the increase in surgical interventions for CRC and the critical role that the gut microbiota plays in overall health.…”

Enhanced Recovery After Surgery (ERAS) Society Consensus Guidelines for Perioperative Care for Emergency Laparotomy: New Horizons

“…Recently, the first perioperative evidence-based ERASÒ Society guideline for emergency laparotomy (part 1) was published which included preoperative management in this surgical field [3]. In the current issue of the Journal, the two next parts (2 and 3) of the ERASÒ Society guidelines are published for intra-and postoperative care and the organizational aspects of emergency laparotomy, respectively [4,5]. Peden, Scott and colleagues are to be commended for these two important new consensus guidelines which are based on the best available evidence for a comprehensive ERAS approach in emergency laparotomy.…”