Modified Enhanced Recovery Program in Emergency Surgery (MERES)

Evaluation of Modified Enhanced Recovery Program in Emergency Surgery

Laparoscopic appendectomy (LA) is a widespread surgical procedure. Patients may develop considerable postoperative pain and dyspepsia resulting in prolong in-hospital stay. Almost 10% of patients develop postoperative complications. Enhanced recovery after surgery (ERAS) program has proven its effectiveness in elective surgery and can theoretically improve outcomes of LA. To date there is no ERAS program for LA. The aim of the study was to investigate the safety and efficacy of a modified ERAS protocol in LA.

A modified ERAS (mERAS) protocol was investigated. The study is a prospective, randomized nonblinded. All patients underwent LA. Modified ERAS protocol included patient informing, limitation of drainage use; intraperitoneal anesthesia with long-acting anesthetics; low-pressure pneumoperitoneum; early mobilization and oral nutrition. Pain level was assessed in rest using visual analogue scale (VAS). The primary endpoint was postoperative length of stay (pLOS).

Inclusion Criteria:

• Patients with any stage of acute appendicitis except 3B according to Gomes classification;
• Class I-II surgical patients according to the classification of The American Society of Anesthesiologists (ASA).

Exclusion Criteria:

• Patient refusal to participate in the study or to sign the informed consent form;
• Language barrier;
• Transfer to the intensive care unit (ICU) after surgery;
• ASA class ≥ III;
• Conversion to open procedure;
• Appendicular mass found during laparoscopy;
• Gomes 3B appendicitis requiring immersion of the appendicular stump;
• Pregnancy.