Using the concept of “Enhanced Recovery After Surgery” in the treatment of complicated uterine fibroids

Objective: to evaluate the clinical efficacy and safety of implementing the Enhanced Recovery After Surgery (ERAS) pathway in the treatment of complicated forms of uterine fibroids to optimize the postoperative period and reduce the incidence of complications.

Material and methods: the study is based on a retrospective comparative analysis of surgical treatment outcomes in 25 (28.7%) women with complicated uterine fibroids operated laparoscopically and 23 (26.4%) women who underwent laparotomic surgery at the Obstetrics and Gynecology Clinic No. 2 of the SEI Institute of Postgraduate Education in Healthcare of the Republic of Tajikistan and the Department of Surgical Diseases No. 1 named after Academician K. M. Kurbonov during 2016 to 2025. Of all the women studied, 16.6% (n = 8, the main group of women - 20.0%, the control group - 13.0%) were younger than 40 years; the remaining 83.4% were 40 years or older.

Results: to implement an ERAS (fast track) pathway, patients in the study group followed a specially developed protocol. A comparative analysis of the procedures performed in women with complicated uterine fibroids showed that supracervical (subtotal) hysterectomy was the most common operation in both groups, performed in 80% of patients in the study group and 91.3% in the comparison group. Mean operative time was significantly shorter in the study group (61.1 ± 10.4 min) than in the control group (79.7 ± 11.3 min). Postoperative complications were almost half as frequent in the ERAS group (7.5% vs 13.3%). Mean length of hospital stay was reduced (4.6 ± 1.5 days vs 11.3 ± 3.7 days). Time to full functional recovery decreased by about 2.5 fold (3.1 ± 0.1 weeks vs 6.9 ± 0.1 weeks).

Conclusion: implementation of ERAS (fast track) principles in the surgical management of complicated uterine leiomyomas appears clinically effective and is associated with earlier mobilization and return of gastrointestinal function, shorter hospitalization, reduced opioid analgesic requirements, and a lower rate of postoperative complications, facilitating faster postoperative rehabilitation. 

1. Zavada N.V. Emergency surgical care in the Republic of Belarus. Military medicine.2019;4:14–21.

2. Turbin M.V., Cherkasov M.F., Bondarenko V.A., Cherkasov D.M., Krasenkov Yu.V. Evaluation of the effectiveness of laparoscopic interventions for acute pelvic pain in women. Endoscopic surgery. 2022;28(6):37-44. https://doi.org/10.17116/endoskop20222806137.

3. Dobrohotova Yu.E., Ter-Ovanesov M.D., Borovkova E.I., Kukosh M.Yu., Zhelezkova T.A. The concept of accelerated recovery after surgery in gynecological oncology. Russian Medical Journal. 2018;5(1):45–50.

4. Puchkov K.V., Korennaya V.V., Podzolkova N.M. Fast Track: Surgical Protocols for Accelerated Recovery in Gynecology. Medical aspects of women’s health. 2016;8(17):59–64.

5. Fateeva A.S., Petrov I.A., Tihonovskaya O.A., Kupriyanova I.I., Logvinov S.V. Reproductive health after radical surgery on the uterus and fallopian tubes. The Journal of scientific articles “Health and Education Millennium”. 2016;18(6):11–17.

6. Carlson S., Brando A., McGregor A.E., Sutaria T., Hurtado E., Frazzini Padilla P., Arnolds K. Comparison of Postoperative Complications Between Laparoscopic Myomectomy and Total Laparoscopic Hysterectomy. Journal Minim. Invasive Gynecol. 2024;31(1):43–48. doi: 10.1016/j.jmig.2023.10.005.

7. Yang Q., Ciebiera M., Victoria Bariani M., Ali M., Elkafas H., Boyer Th.G., Al-Hendy A. Comprehensive Review of Uterine Fibroids: Developmental Origin, Pathogenesis, and Treatment. Endocr. Rev.2022;43(2):678–719. doi: 10.1210/endrev/bnab039.

8. Raffone A., Raimondo D., Neola D., Travaglino A., Giorgi M., Lazzeri L. et all. Diagnostic accuracy of MRI in the differential diagnosis between uterine leiomyomas and sarcomas: A systematic review and meta-analysis. Int. J. Gynaecol. Obstet.2024;165(1):22–33. doi: 10.1002/ijgo.15136.

9. Rodriguez-Triana VM., Kwan L., Kelly M., Olson T.H., Parker W.H. Quality of Life after Laparoscopic and Open Abdominal Myomectomy. J. Minim. Invasive Gynecol. 2021;28(4):817–823. doi: 10.1016/j.jmig.2020.07.023.