Comparison of stress response, post-operative complications, and recovery between the enhanced recovery after surgery (ERAS) vs standard protocol in patients undergoing laparoscopic cholecystectomy: A prospective observational study from northern India

Background: The goal of the Enhanced Recovery After Surgery (ERAS) protocol is to reduce the surgical stress response to promote better postoperative recovery. Widespread adoption of the ERAS initiative has resulted in extending standards for various surgical specialties, especially in colorectal surgery. In this study, patients undergoing laparoscopic cholecystectomy had their perioperative stress response, postoperative problems, and rehabilitation assessed through a modified ERAS procedure. Methods: 120 patients were enrolled in a prospective observational research and randomly assigned to the ERAS (case) or standard treatment (control) groups. Important elements of the ERAS procedure were multimodal analgesia, carbohydrate loading, and preoperative education. Measurements of serum glucose, cortisol, total leukocyte count (TLC), and C-reactive protein (CRP) were performed both before and after surgery. Result: The postoperative serum glucose and cortisol levels were significantly lower (p < 0.001) in the ERAS group. Serum glucose levels in the ERAS group were greater 6 h after surgery and right before (p < 0.001). Following surgery, the control group's serum cortisol levels were considerably higher (p < 0.001). Additionally, the ERAS group experienced fewer problems at discharge, including fever (p = 0.01), vomiting (p = 0.004), and nausea (p = 0.03), and had lower PONV intensity scores at 24 h (p = 0.012). Furthermore, the ERAS group started oral feedings sooner and spent a considerably lower amount of time in the hospital (p < 0.001). Conclusion: The modified ERAS protocol is beneficial in enhancing perioperative care and outcomes by reducing the surgical stress response and improving recovery in patients undergoing laparoscopic cholecystectomy.