Recovery · Patient education

Recovery after digestive surgery: the ERAS protocol

A few decades ago, after abdominal surgery, patients spent days without eating, with tubes and drains, confined to bed. Today we know that this way of "sparing" the body actually delays healing. The ERAS protocol has completely changed how we prepare for surgery and recover from it — and the patient plays an active role in the process.

What ERAS is

ERAS stands for Enhanced Recovery After Surgery. It is not a drug or a surgical technique, but a set of simple, evidence-based measures applied before, during and after the operation. Each measure brings a small gain on its own; together they reduce the stress placed on the body and help it recover much faster.

Studies show that, when properly applied, ERAS reduces postoperative complications and shortens hospital stay — by about two days on average after colorectal surgery — without increasing the risk of readmission.

ERAS works best when the patient, surgeon, anaesthetist and nursing team work together. Many of the steps depend directly on you.

Before surgery: preparation matters

  • Information. A patient who knows what to expect is calmer and recovers better. Ask about anything that worries you at the consultation.
  • Movement ("prehabilitation"). In the weeks before surgery, a daily walk — ideally 30 minutes — and breathing exercises build up your physical reserve. The fitter you go into surgery, the faster you come out of it.
  • Stopping smoking at least 4 weeks beforehand significantly reduces lung and wound-healing complications. Alcohol should also be avoided.
  • Nutrition. Good nutrition, with enough protein, is essential. If you have lost a lot of weight recently, let us know — sometimes we recommend nutritional supplements before surgery.
  • No prolonged fasting. "Nothing after midnight" is no longer needed. As a rule, solid food is allowed up to 6 hours before anaesthesia and clear fluids up to 2 hours before; a special carbohydrate drink is often recommended as well. Always follow the exact instructions from your anaesthetic team.

During surgery

This part is the medical team's responsibility, but it helps to know what it involves:

  • Minimally invasive surgery — laparoscopic or robotic — whenever possible. Small incisions mean less pain and faster mobilisation.
  • Modern anaesthesia, with short-acting drugs and careful control of the fluids given.
  • Keeping the body warm and preventing postoperative nausea and vomiting.
  • As few tubes as possible. Nasogastric tubes, drains and catheters are used only when truly needed and removed as early as possible.

After surgery: the first days

Eating and drinking

In most cases you will be able to drink fluids on the day of surgery, and eating resumes gradually from the first or second day. The bowel recovers faster when it receives food early. Chewing gum can also help bowel function return.

Getting moving

You will be encouraged to get out of bed within the first 24 hours — first to a chair, then a few steps along the corridor. Movement prevents blood clots, lung complications and muscle weakness. Each day, the goal increases a little.

Pain control

Well-controlled pain is a condition for recovery, not a luxury. We use a combination of medicines and techniques that minimise the need for opioids (which can slow the bowel and cause nausea). Always tell us if pain stops you from moving or breathing deeply.

Breathing

Deep-breathing exercises and controlled coughing, a few minutes every hour while awake, help keep the lungs well ventilated after anaesthesia.

At home: what to watch for

You will go home when you are eating normally, pain is controlled with tablets, you are moving independently and bowel function has returned. Recovery continues at home: daily walks, balanced meals and no heavy lifting in the first weeks, as advised at discharge.

Contact the medical team or go to the emergency department if you notice:

  • fever above 38 °C (100.4 °F) or chills;
  • abdominal pain that gets worse instead of better;
  • persistent nausea or vomiting, or being unable to eat;
  • redness, swelling or discharge from the incisions;
  • no passage of wind or stool, with significant bloating;
  • a swollen or painful leg, shortness of breath or chest pain.

The bottom line

ERAS means active preparation before surgery, an operation that is as gentle as possible, and a quick return to eating and moving afterwards. The result is less pain, fewer complications and a faster return home. The protocol is adapted to each patient — and your involvement makes a real difference.

Your journey, from consultation to recovery →
← All articles