2017 SSAT PLENARY PRESENTATION Adapted ERAS Pathway vs. Standard Care in Patients with Perforated Duodenal Ulcer—a Randomized Controlled Trial Subair Mohsina 1 & Dasarathan Shanmugam 1 & Sathasivam Sureshkumar 1 & Pankaj Kundra 2 & T. Mahalakshmy 3 & Vikram Kate 1 Received: 18 April 2017 /Accepted: 8 June 2017 # 2017 The Society for Surgery of the Alimentary Tract Abstract Objectives The objective of this study was to evaluate the feasibility and efficacy of ERAS pathways in patients undergoing emergency simple closure of perforated duodenal ulcer (PDU). Methods This single-center, prospective, open-labeled, superiority, RCT was carried out from August 2014 to July 2016. Patients of PDU undergoing open simple closure were randomized preoperatively in 1:1 ratio into standard care and adapted ERAS group. Patients with refractory shock, ASA class ≥3, and perforation size ≥1 cm were excluded. Primary outcome was the length of hospitalization (LOH). Secondary outcomes were functional recovery parameters and morbidity. Results Forty-nine and 50 patients were included in standard care and ERAS group, respectively. Patients in ERAS group had a significantly early functional recovery (days) for the time to first flatus (1.47 ± 0.18; p < 0.001), first stool (2.25 ± 0.20; p < 0.001), first fluid diet (2.72 ± 0.38; p < 0.001), and solid diet (3.70 ± 0.44; p < 0.001). LOH in ERAS group was significantly shorter (mean difference of 4.41 ± 0.64 days; p < 0.001). There was a significant reduction in postoperative morbidity such as superficial SSI (RR 0.35, p = 0.02), postoperative nausea and vomiting (RR 0.28, p < 0.0001), and pulmonary complications (RR 0.24, p = 0.04) in the ERAS vs. standard care group with similar leak rates (1/50 vs.2/49). Conclusion ERAS pathways are safe and feasible in select patients undergoing emergency simple closure of PDU. Keywords LOH . Enhanced recovery . Bowel functions . NG tube . Drain Introduction The advancements in the field of surgery and anesthesia have led to revolutionary revision in the perioperative care referred to as the enhanced recovery after surgery (ERAS) or fast-track protocols. ERAS protocols, pioneered by Henrik Kehlet in the late 1990s, is a streamlined multimodal approach which uti- lizes various evidence-based modifications of the periopera- tive care elements with the aim of attenuating the physiolog- ical and psychological stress, thus accelerating patients’ re- covery [ 1 ]. This multifaceted approach aims at a Bpainless and safe^ surgery for the patient. ERAS protocols have now become the standard of care in many procedures across specialties demonstrating a shorter hospital stay and reduced postoperative morbidity and mortal- ity [ 2–8 ]. Meta-analyses have demonstrated a reduction of 2– 4 days in the length of hospitalization (LOH), earlier mobili- zation, nutrition, and a significant reduction in complication rates following elective upper and lower gastrointestinal sur- gery [ 9–12 ]. However, despite its success in the elective setting, the perioperative care in the emergency setting still continues to utilize the traditional principles [ 2 ]. Recent evidence has found many of these traditional principles to be unnecessary and rather harmful [ 1 ]. The higher morbidity and mortality rate * Vikram Kate drvikramkate@gmail.com 1 Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605006, India 2 Department of Anaesthesia and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605006, India 3 Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605006, India J Gastrointest Surg DOI 10.1007/s11605-017-3474-2