Implementation of Modified Enhanced Recovery After Surgery Protocols for Elective Incisional Hernia Repair After Damage Control Surgery: A Retrospective Observational Study

Abstract

The ongoing full-scale war in Ukraine has led to a significant increase in the number of patients undergoing damage control surgery following abdominal shrapnel wounds. These injuries are consistently associated with extensive soft tissue defects of the abdominal wall and secondary wound healing that frequently lead to the formation of large ventral hernias. In such patients, the primary goal is to provide the safest possible treatment and facilitate rapid recovery. The implementation of Enhanced Recovery After Surgery (ERAS) protocols has shown proven benefits in elective surgical settings. However, their use in ventral hernia repair remains insufficiently studied. The aim of this study is to evaluate the safety and effectiveness of adapted ERAS protocols in the management of ventral hernias after damage control surgery. This retrospective cohort study included 62 males divided into two groups based on the treatment period. Patients treated in the period before September 2024 received standard care (non-ERAS group), and those treated between September 2024 and April 2025 received treatment with implementation of ERAS protocols (ERAS group). All surgical procedures were performed using an open approach. Intraoperative and postoperative parameters were compared, including operative time, pain intensity, bowel function recovery, and length of hospital stay. The components of the ERAS protocols included opioid-free pain management, the avoidance of intra-abdominal drains, early feeding, and early mobilisation. The implementation of modified ERAS protocols led to an improvement in clinical outcomes. The mean hospital stay was shorter in the ERAS group (12.07 compared with 16.47 days, p < 0.001). The timing of the first postoperative bowel movement differed significantly between the groups, with 93.3% of ERAS patients passing stool by postoperative day 2 compared with 15.6% in the non-ERAS group (p < 0.001). The mean Visual Analogue Scale score was lower in ERAS group on postoperative day 2 (3.83 compared with 5.47, p < 0.001). No increase in postoperative complications was observed in the ERAS group. The application of modified ERAS protocols was safe and effective for patients with ventral hernias after abdominal injuries and led to a reduced hospital stay, faster restoration of bowel function and decreased postoperative pain.