Enhanced Recovery After Surgery — ERAS — is a bundle of small, evidence-based changes that together shorten hospital stay, reduce complications and get patients back to normal life faster. None of the individual elements is dramatic. The combined effect is one of the most significant improvements in surgical care of the last two decades, and it applies directly to gynecologic keyhole surgery.
Preparation starts weeks before
Prehabilitation means arriving in the best condition we can achieve: treating anaemia and iron deficiency, optimising blood sugar, stopping smoking, and building basic aerobic and strength capacity. Correcting iron deficiency alone measurably reduces transfusion rates and speeds recovery.
Anxiety is treated as a clinical variable too. Patients who know exactly what will happen, hour by hour, need less pain medication afterwards — which is precisely why our pre-operative counselling is detailed.
Early walking and early eating are not signs of a tough patient. They are part of the prescription.
The end of prolonged fasting
Overnight fasting from midnight is outdated. Clear fluids are now permitted up to two hours before anaesthesia, and a carbohydrate drink beforehand reduces insulin resistance, thirst and post-operative nausea. Patients feel noticeably better on the day.
Routine bowel preparation has also been abandoned for most gynecologic surgery — it caused dehydration and discomfort without improving outcomes.
Opioid-sparing pain control
Modern pain management layers regional local anaesthetic, paracetamol and anti-inflammatories, using stronger opioids only as rescue. The result is comparable comfort with far less nausea, constipation and grogginess — and patients who can actually get out of bed.
Early eating, early walking
Eating within hours and walking on the day of surgery are not tests of toughness; they are treatments. Early mobilisation lowers clot risk, restores bowel function faster and clears the residual gas that causes shoulder-tip pain. Most of our keyhole patients are walking within four to six hours.
How to prepare your body before surgery
- Have iron and haemoglobin checked and corrected in advance
- Walk daily and add light strength work in the weeks before
- Stop smoking as early as possible before the date
- Follow the modern fasting instructions — including the carbohydrate drink
Common questions
Is early eating after surgery safe?
Yes, for the great majority of gynecologic procedures. Early feeding is associated with faster bowel recovery and shorter stay, not with higher complication rates.
Will I be in more pain with fewer opioids?
No. Layered pain control gives comparable comfort with far fewer side effects, and stronger medication remains available whenever it is needed.
Book a consultation with Prof. Parkar
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