Comparative Analysis of enhanced recovery after surgery protocols versus Standard Care in incisional hernia

Fionn Doyle; R. Byrne; R. Walsh

doi:10.5281/zenodo.22813373

Authors

Fionn Doyle Department of Clinical General Surgery, Danube Institute of General Surgery Author https://orcid.org/2450-0118-7962-9185
R. Byrne Division of General Surgery, Ebro Center for Surgical Research Author https://orcid.org/2517-7655-3464-2384
R. Walsh Department of Surgical Research, Snake Academy of Surgical Research Author https://orcid.org/4153-9156-3281-1459

DOI:

https://doi.org/10.5281/zenodo.22813373

Keywords:

Enhanced recovery after surgery, Incisional hernia, Perioperative care, Surgical site infection, Length of stay

Abstract

Graphical abstract

Enhanced recovery after surgery (ERAS) protocols bundle preoperative counselling, opioid-sparing multimodal analgesia, early mobilization and early oral intake, and have reduced length of stay and complications across colorectal, gynecologic and hepatobiliary surgery, but their value in elective incisional hernia repair, a population with high rates of obesity, prior wound infection and abdominal wall laxity, remains comparatively under-studied. This retrospective comparative cohort analysis evaluated consecutive adult patients undergoing elective open or laparoscopic mesh repair of incisional hernia, comparing those managed on a structured ERAS pathway against a historical standard-care cohort at the same institution. The primary outcome was postoperative length of stay; secondary outcomes included 30-day surgical site infection, opioid consumption, time to first bowel movement, readmission and overall complication rate graded by Clavien-Dindo classification. The ERAS cohort had a significantly shorter median length of stay, lower opioid consumption, earlier return of bowel function and a lower surgical site infection rate than the standard-care cohort, with no significant difference in 30-day readmission or reoperation. These findings support extending structured enhanced recovery pathways to elective incisional hernia repair as a means of improving perioperative outcomes without compromising safety.

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