Enhanced Recovery After Surgery (ERAS) Protocol for Abdominal Wall Reconstruction. A Scoping Review of Items Included in Current Protocols.

Abstract

The aim of this scoping review is to report the different items employed in Enhanced Recovery After Surgery (ERAS) protocols for the management of patients who underwent abdominal wall reconstruction (AWR). This highlights not only the variability between ERAS protocols, but also the heterogeneity, and in some cases conflicting proposals, of specific items within ERAS categories across the included studies. After PROSPERO registration (CRD-42025635207), systematic research was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The search was carried out in the PubMed, Embase, and Web of Science databases. Thirty-four articles were fully analyzed, and 23 articles were excluded. One article was included by checking references of related articles. Finally, 12 articles were included. We did not focus on the clinical outcomes of the ERAS protocols, but rather on the specific items included. A total of 140 ERAS items were identified and grouped in categories as follows: preoperative counseling/preparation, optimizing nutrition/diabetes control, thromboprophylaxis, minimizing nausea and vomiting, fluid management, normothermia, drains and tubes management, multimodal analgesia, early mobilization, intestinal recovery and other intra- and postoperative items. This highlights not only the variability between ERAS protocols, but also the heterogeneity, and in some cases conflicting proposals, of specific items within ERAS categories across the included studies. This scoping review provides a valuable snapshot of current items in ERAS protocols in AWR. Importantly, given the predominantly retrospective design and heterogeneity in protocol items/categories and the limited quality of evidence, no strong item-specific recommendations can currently be formulated. This calls for further research, particularly large-scale, randomized trials or registry data, to better define the optimal categories (and their items) of ERAS protocols for this patient population.