Effects of enhanced recovery after surgery on postoperative intestinal function and intestinal flora during laparoscopic gastric cancer surgery.

Background: Enhanced recovery after surgery (ERAS) protocols have emerged as a promising approach in perioperative care. This study evaluated ERAS's impact on gastrointestinal recovery and microbiota composition following laparoscopic gastric cancer surgery.

Aim: To evaluate the impact of ERAS protocols on postoperative gastrointestinal function recovery and intestinal microbiota composition in patients undergoing laparoscopic gastric cancer surgery, and to identify factors associated with improved clinical outcomes and microbial diversity preservation.

Methods: We conducted a retrospective analysis of 80 patients who underwent laparoscopic D2 gastrectomy, comparing ERAS (n = 40) vs traditional care (n = 40). Primary outcomes included postoperative gastrointestinal function recovery and complications. Intestinal microbiota was analyzed using 16S rRNA sequencing at multiple timepoints perioperatively.

Results: ERAS patients demonstrated faster recovery of bowel function, with earlier return of bowel sounds (16.25 ± 6.41 hours vs 22.3 ± 6.49 hours), first flatus (23.95 ± 6.02 hours vs 28.45 ± 7.12 hours), and defecation (34.95 ± 9.34 hours vs 48.1 ± 15.64 hours), all P < 0.05. Complication rates, including antibiotic-associated diarrhea and surgical site infections, were comparable between groups. Microbial diversity indices and probiotic populations showed better preservation in the ERAS group postoperatively (P < 0.05), though neither group achieved complete restoration to preoperative levels at one month.

Conclusion: These results support tailoring ERAS protocols to prioritize gut microbiome resilience through early feeding and shortened antibiotic courses, with particular benefits for younger patients.