Implementation of enhanced recovery after surgery (ERAS) protocols in patients with metabolic syndrome in abdominal surgery

Efforts to standardize methods of perioperative management of patients prompted the creation of appropriate algorithms. The rapid development of modern surgery, the introduction of minimally invasive surgical techniques, the improvement of anesthesiological services, and also the placing of emphasis on the deepening of pathophysiological processes, which are important for achieving the maximum effectiveness of treatment and patient safety. Thus began the era of implementation of enhanced recovery after surgery (ERAS) protocols on the practice. At the same time, such tactics, in certain cases, do not take into account individual concomitant conditions of patients, which can complicate the course of the perioperative period and endanger the life and health of the patient. Metabolic syndrome is just such a condition, the neglect of which is frivolous on the part of the doctor, because with much greater risks it can provoke the development of cardiovascular, respiratory, infectious and other complications, which worsens the prognosis of treatment and also increases the economic costs of treating such patients. The paradox is that, despite its significant prevalence in the world population, there are relatively few scientific works investigating the influence of metabolic syndrome on the course of the perioperative period in the context of ERAS. Considering the prevalence of this condition among the population and the presence of hidden forms of metabolic disorders, the metabolic syndrome clearly deserves additional attention from the doctor and may require additional research on the development and implementation of new strategies for enhanced recovery after surgery protocols taking into account this pathology in the long term. This article presents the main components of ERAS protocols in colorectal and general abdominal surgery with an emphasis on the specifics of their implementation in patients with metabolic syndrome. In particular, specific details of both the surgical and anesthetic pathways of ERAS are provided in terms of preoperative, postoperative, and postoperative care.