Enhanced recovery after surgery (ERAS) protocols in inguinal hernia surgery: current state of the problem. Review
DOI:
https://doi.org/10.30978/GS-2026-2-81Keywords:
hernia, inguinal, herniorrhaphy, enhanced recovery after surgery, laparoscopy, postoperative care, analgesia, multimodal, postoperative painAbstract
Inguinal hernia remains one of the most common surgical conditions worldwide. Despite substantial advances, including the development of minimally invasive hernia repair techniques, issues related to functional treatment outcomes are still relevant, particularly the intensity of early postoperative pain, time to return to usual physical activity, quality of life, and the risk of chronic postoperative inguinal pain (CPIP). In this context, Enhanced Recovery After Surgery (ERAS), also known as accelerated postoperative recovery, represents a promising model for standardizing perioperative management in patients with inguinal hernias.
Objective – of this review was to summarize current data on the application of ERAS principles in inguinal hernia surgery, with an emphasis on preoperative, intraoperative, and postoperative components, and their potential impact on pain, functional recovery, length of hospital stay, complication rates, and patient-reported outcomes.
The review examines the role of preoperative patient education, risk stratification, correction of comorbidities, rationalization of preoperative fasting, prevention of postoperative nausea and vomiting, selection of the surgical approach and method of prosthetic material fixation, multimodal analgesia, maintenance of normothermia, individualized infusion therapy, selective antibiotic prophylaxis, early mobilization, resumption of oral nutrition, prevention of urinary retention, and thromboprophylaxis. The implementation of ERAS in inguinal hernia surgery involves adapting the general principles of enhanced recovery to address key challenges in herniology: minimizing early and chronic pain, reducing opioid exposure, accelerating functional recovery, ensuring safe early discharge, and improving patients’ quality of life. Laparoscopic techniques, such as transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) repairs, offer advantages within the ERAS framework compared with open techniques, provided that adequate material and technical resources are available. Nevertheless, the choice of surgical treatment method should be individualized for each patient. Future efforts should now focus on establishing unified, hernia-specific ERAS protocols and prioritizing prospective studies that assess long-term treatment outcomes.
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