ENHANCED RECOVERY AFTER SURGERY (ERAS) PROTOCOLS IN COLORECTAL SURGERY: A CONTEMPORARY REVIEW

Abstract

Enhanced Recovery After Surgery (ERAS) protocols are structured, evidence-based, multimodal perioperative care pathways originally developed for colorectal surgery in the early 2000s and now supported by four successive iterations of ERAS Society guidelines, most recently updated in 2025. ERAS routes seek to mitigate the surgical stress response and expedite functional recovery by combining preoperative optimization, minimally invasive and stress-reducing intraoperative procedures, and postoperative measures that prioritize early mobilization and feeding. This review summarizes the historical development, core components, and current evidence base for ERAS in colorectal surgery, with particular attention to the 2025 ERAS Society guideline update, compliance-outcome relationships, and persisting implementation barriers. ERAS implementation is consistently linked to shorter hospital stays and fewer postoperative complications without a corresponding rise in readmission or mortality across systematic reviews and meta-analyses. However, benefits are highly compliance-dependent, highlighting the significance of institutional audit and ongoing quality improvement.