Enhanced recovery after surgery (ERAS) for deep infiltrating endometriosis surgery: Experience of a French center

Enhanced recovery after surgery (ERAS) is based on a global and multidisciplinary approach to perioperative management of patients with the objective of early recovery of their capacities after surgery [1]. ERAS programmes were initially set up in digestive and colorectal surgery and then gradually developed in other surgical specialties [1], [2], [3], [4].

According to the guidelines of the ‘Haute Autorité de Santé’ published in 2016 and to the Guidelines for perioperative care in gynaecologic/oncology updates in 2019 [5,6]. ERAS programmes have the following principles: limitation of the duration of preoperative fasting, fluid intake up to 2 h of intervention, screening and correction of preoperative anaemia, reduction in the use of drains and nasogastric tubes, early removal of catheters, morphine sparing and multimodal analgesia, minimally invasive surgical techniques preferred [7], early mobilisation and refeeding . According to the literature, ERAS reduces the length of stay (LOS) without increasing the rate of complications or rehospitalisation [11,12].

Endometriosis is a frequent pathology, with an estimated prevalence of around 10 % of premenopausal women [13]. An advanced form of this pathology is deep pelvic endometriosis (DPE), which is located mainly in the posterior compartment of the pelvis, the uterosacral ligaments (USL), the posterior vaginal fornix and the anterior face of the rectum. DPE may require a large and complex surgical procedure for which ERAS can be interesting and needs to be further evaluated [14], [15], [16].

In France, the use of ERAS in obstetrics and gynaecology is not widespread and poorly evaluated [15,16]. The criteria used are often different from one study to another, making analysis difficult [8,18]. In gynaecology, ERAS has been evaluated mainly for oncological surgery [7,19], but it has recently been evaluated more specifically for obstetrics and gynaecology, allowing for more specific recommendations [17,20,21]. For these reasons, it seems interesting to report data on DPE surgery through an ERAS programme. This study aimed to evaluate the implementation of an ERAS programme for DPE surgery.

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