Enhanced recovery after surgery protocol allows ambulatory laparoscopic appendectomy in uncomplicated acute appendicitis: a prospective, randomized trial

  • Mario E. Trejo-Ávila
  • Sujey Romero-Loera
  • Eduardo Cárdenas-Lailson
  • Miguel Blas-Franco
  • Roberto Delano-Alonso
  • Carlos Valenzuela-Salazar
  • Mucio Moreno-Portillo



Previous observational studies have demonstrated the safety of discharging patients after laparoscopic appendectomy within the same day without hospitalization. The application of Enhanced Recovery After Surgery (ERAS) guidelines has resulted in shorter length of stay, fewer complications, and reduction in medical costs. The aim of this study was to investigate if ERAS protocol implementation in patients with acute uncomplicated appendicitis decreases the length of stay enough to allow for ambulatory laparoscopic appendectomy.


In this prospective, randomized controlled clinical trial, 108 patients were randomized into two groups: laparoscopic appendectomy with ERAS (LA-E) or laparoscopic appendectomy with conventional care (LA-C). The primary endpoint was postoperative length of stay. The secondary end points were time to resume diet, postoperative pain, postoperative complications, re-admission rate, and reoperation rate.


From January 2016 through May 2017, 50 patients in the LA-E group and 58 in the LA-C were analyzed. There were no significant differences in preoperative data. Regarding the primary end point of the study, the ERAS protocol significantly reduced the postoperative length of stay with a mean of 9.7 h (SD: 3.1) versus 23.2 h (SD: 6.8) in the conventional group (p < 0.001). The ERAS protocol allowed ambulatory management in 90% of the patients included in this group. There was a significant reduction in time to resume diet (110 vs. 360 min, p < 0.001) and less moderate–severe postoperative pain (28 vs. 62.1%, p < 0.001) in the LA-E versus LA-C group. The rate of complications, readmissions, and reoperations were comparable in both groups (p = 0.772).


ERAS implementation was associated with a significantly shorter length of stay, allowing for the ambulatory management of this group of patients. Ambulatory laparoscopic appendectomy is safe and feasible with similar rates of morbidity and readmissions compared with conventional care.


Acute appendicitis Enhanced recovery after surgery Ambulatory surgery Laparoscopic appendectomy 



We would like to thank Violeta Díaz-Fermin MD, for helping us in collecting data.

Compliance with Ethical Standards


Mario E. Trejo-Ávila, Sujey Romero-Loera, Eduardo Cárdenas-Lailson, Miguel Blas-Franco, Roberto Delano-Alonso, Carlos Valenzuela-Salazar, and Mucio Moreno-Portillo have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Mario E. Trejo-Ávila
    • 1
  • Sujey Romero-Loera
    • 1
  • Eduardo Cárdenas-Lailson
    • 1
  • Miguel Blas-Franco
    • 1
  • Roberto Delano-Alonso
    • 1
  • Carlos Valenzuela-Salazar
    • 1
  • Mucio Moreno-Portillo
    • 1
  1. 1.Department of General and Endoscopic SurgeryHospital General Dr. Manuel Gea GonzálezMexico CityMexico

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