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Abstract
Background: Perforated duodenal ulcer (PDU) is a potentially life-threatening surgical emergency, there is significant morbidity and generally long term hospitalisation. There is a relative scarcity of evidence for use of Enhanced Recovery After Surgery (ERAS) pathways in emergency abdominal surgery, when compared to elective surgery.
Objective: To comparepost-surgical outcomes of tailored-enhanced recovery versus conventional care in patients with duodenal ulcer perforation.
Methods: This was a Randomized Controlled trial that was carried out at Department of Surgery, Nishtar Hospital Multan from June 2024 to December 2024. 60 patients, aged 18-60 years were randomized evenly to both t-ERAS and conventional-care groups. The t-ERAS protocol included early mobilization, early oral feeding, multimodal non-opioid analgesia and early tube, drain and urinary catheter removal. Primary and secondary outcomes measured were hospital length of stay (LOS), need for additional analgesia, occurrence of an organ-space surgical-site infection (SSI) with leakage, and 30-day readmission.
Results: The mean hospital stay in the t-ERAS group was significantly reduced compared to that of the conventional-care group (6.12 ± 1.98 days vs 9.45 ± 4.12 days; p < 0.001). Extra analgesia was required by 3 (10.0%) versus 9 (30.0%) patients, respectively (p = 0.050). There were no differences between groups with regard to organ-space SSI with leakage or 30-day readmission.
Conclusion: A personalized ERAS pathway is safe and improves recovery after emergency Graham's patch repair and minimizes hospitalization and requirement for rescue analgesics without increasing postoperative complications.