The basic components of the ERAS protocol include pre-operative counselling to psychologically prepare the patient for the surgery, avoidance of fasting, preoperative nutrition including carbohydrate loading upto two hours prior to surgery, analgesic regimes including epidural and non-opioid analgesia, mobilization and resumption of enteral feeding. There is ample evidence that ERAS protocol hastens postoperative recovery leading to improved outcome, including early oral intake, early mobilization, shorter hospital stay and, thus, higher satisfaction among patients. Carbohydrate loading, suggested by ERAS protocol reduces the postoperative stress induced insulin resistance and also minimizes nitrogen and protein losses. It promotes faster recovery through faster return of bowel function, shorter length of hospital stays (LOS), and thus, better perioperative feeling of well-being.

ERAS protocol had been widely studied in laparoscopic cholecystectomies (LC). Yu Tianyang MM et al in a retrospective study on 126 patients reported that the ERAS group had significantly earlier time to first flatus, time to first ambulation, time to solid intake compared with the traditional group. Further, the ERAS group had significantly lower postoperative lung and abdominal cavity infection compared to the traditional group.Udayasankar M et al (2020) performed a prospective randomized controlled study in 50 patients reported lower anxiety prior to surgery and at 6 hours postoperatively. Hunger, thirst and fatigue were also decreased with better overall perioperative experience. Zhang N et al (2020) performed a retrospective analysis of 445 patients who underwent LC with biliary duct exploration and found that the WBC count and CRP levels were significantly lower among those who underwent LC with ERAS protocol than those without ERAS protocol one day after surgery. Flatus time, length of hospital stays after surgery, incidence of nausea, incisional pain and vomiting were lower in the ERAS group compared to the non-ERAS group. Nair A et al (2023) did a systematic review and meta-analysis and reported that the LOS, time to first flatus was found to be significantly shorter in the ERAS group than the control group, for both LC and LC with CBD exploration. Among patients who underwent LC, incidences of PONV and pain scores were lower in ERAS group compared to conventional group.

Among abdominal open surgeries, ERAS protocols have been studied in colo-rectal, vascular, thoracic and radical cystectomies surgeries.  but there is no report in literature, about the effects of ERAS protocols in radical cholecystectomies. ERAS society published the guidelines for perioperative care in elective abdominal and pelvic surgeries in LMIC in 2022 to improve the perioperative care and to promote data driven, evidence-based care.