Enhancing recovery and reducing inflammation: the impact of enhanced recovery after surgery recommendations on inflammatory markers in laparoscopic surgery-a scoping review

Carlos Darcy Alves Bersot; Lucas Ferreira Gomes Pereira; Victor Gabriel Vieira Goncho; José Eduardo Guimarães Pereira; Luiz Fernando Dos Reis Falcão

doi:10.3389/fsurg.2024.1450434

Enhancing recovery and reducing inflammation: the impact of enhanced recovery after surgery recommendations on inflammatory markers in laparoscopic surgery-a scoping review

Front Surg. 2024 Dec 9:11:1450434. doi: 10.3389/fsurg.2024.1450434. eCollection 2024.

Authors

Carlos Darcy Alves Bersot^{1

2}, Lucas Ferreira Gomes Pereira^{1

3}, Victor Gabriel Vieira Goncho^{1

2}, José Eduardo Guimarães Pereira⁴, Luiz Fernando Dos Reis Falcão^{1

5}

Affiliations

¹ Department of Anesthesia, BP Hospital - A Beneficência Portuguesa de São Paulo (Anextesia), São Paulo, Brazil.
² Postgraduate in Translational Medicine of the Paulista School of Medicine, EPM-UNIFESP, São Paulo, Brazil.
³ Discipline of Anesthesiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
⁴ Department of Anesthesiology, Hospital Unimed Volta Redonda, Rio de Janeiro, Brazil.
⁵ Department of Anesthesiology, Pain and Critical Care Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil.

Abstract

Introduction: The relationship between the Enhanced Recovery After Surgery (ERAS) guidelines and inflammatory markers in laparoscopic surgery has garnered increasing attention. These recommendations are designed to minimize surgical stress and potentially improve recovery outcomes by modifying perioperative care.

Objective: This scoping review aims to evaluate the impact of ERAS recommendations on inflammatory markers in patients undergoing laparoscopic surgeries, identifying current research gaps and consolidating findings from existing studies.

Methods: Guided by the Cochrane Handbook for Systematic Reviews and adhering to the PRISMA-ScR guidelines, this review analyzed studies from databases like PubMed, Scopus, and Cochrane Library. We included both randomized controlled trials and observational studies that assessed inflammatory markers such as C-reactive protein (CRP), white blood cells (WBC), and Interleukin-6 (IL-6) in laparoscopic surgery patients managed with ERAS recommendations.

Results: Out of 64 initial studies, 7 met the inclusion criteria, involving a total of 2,047 patients. Most of the studies focused on laparoscopic colorectal surgeries. Commonly assessed markers were CRP and WBC. The findings consistently showed that ERAS guideline could mitigate the inflammatory response, evidenced by reduced levels of CRP and IL-6, which correlated with fewer postoperative complications and expedited recovery.

Conclusion: ERAS recommendations appear to beneficially modulate inflammatory responses in laparoscopic surgery, which suggests a potential for enhanced recovery outcomes. However, the evidence is currently limited by the small number of studies and inherent methodological biases. Further robust RCTs are required to strengthen the evidence base and refine these protocols for broader clinical application.

Systematic review registration: https://osf.io/tj8mw/.

Keywords: anesthesia; enhanced recovery after surgery; inflammation; laparoscopy; surgery.

Publication types

Systematic Review

Grants and funding

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.