{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:31:45Z","timestamp":1790573505563,"version":"4.1.0"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p>Haemorrhoid surgery, while typically performed as a low-risk outpatient procedure, is frequently associated with considerable postoperative discomfort, delayed return to daily activities, and occasional unplanned healthcare visits. Enhanced recovery protocols, originally developed to improve outcomes in major abdominal surgery, offer a structured, evidence-based framework for optimizing perioperative care and accelerating recovery. This review explores whether these principles can be effectively applied to the context of haemorrhoidectomy. Key components such as patient education, multimodal pain control, minimal preoperative fasting, early mobilization, and structured discharge planning are conceptually well-suited to the needs of patients undergoing benign anorectal surgery. Early clinical experiences and extrapolated data from related surgical settings suggest that even minor procedures may benefit from standardized recovery pathways, with reported reductions in postoperative pain scores of up to forty percent, faster return to function by two to three days, and nearly fifty percent fewer unplanned return visits. These findings support the potential for improved pain management, reduced variability in care, and enhanced patient satisfaction. However, current evidence remains limited, with few studies specifically addressing the impact of enhanced recovery protocols in haemorrhoidectomy. This article synthesizes the available literature, highlights potential advantages and implementation challenges, and advocates for the development of a simplified, procedure-specific perioperative pathway tailored to the characteristics of this common surgical intervention. The integration of digital follow-up tools and individualized care strategies may further support recovery and reduce complications in this setting. Overall, a targeted and pragmatic approach to enhanced recovery in haemorrhoid surgery represents a clinically meaningful opportunity to improve outcomes and modernize care delivery in proctology.<\/jats:p>","DOI":"10.3389\/fsurg.2026.1728394","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T06:47:16Z","timestamp":1770187636000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Enhanced recovery pathways improve postoperative outcomes in haemorrhoid surgery: a narrative review"],"prefix":"10.3389","volume":"13","author":[{"given":"Alin","family":"Kraft","sequence":"first","affiliation":[{"name":"Department of Medical-Surgical and Prophylactic Disciplines, Faculty of Medicine, Titu Maiorescu University","place":["Bucharest, Romania"]},{"name":"Department of General Surgery, \u201cGeneral Doctor Aviator Victor Anastasiu\u201d National Aeronautical and Space Medicine Institute","place":["Bucharest, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cosmin Alec","family":"Moldovan","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical and Prophylactic Disciplines, Faculty of Medicine, Titu Maiorescu University","place":["Bucharest, Romania"]},{"name":"Department of General Surgery, Witting Clinical Hospital","place":["Bucharest, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Rusu","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical and Prophylactic Disciplines, Faculty of Medicine, Titu Maiorescu University","place":["Bucharest, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Cochior","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical and Prophylactic Disciplines, Faculty of Medicine, Titu Maiorescu University","place":["Bucharest, Romania"]},{"name":"Department of General Surgery, Sanador Hospital","place":["Bucharest, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1097\/DCR.0000000000001090","article-title":"An enhanced recovery after surgery (ERAS) protocol for ambulatory anorectal surgery reduced postoperative pain and unplanned returns to care","volume":"61","author":"Parrish","year":"2018","journal-title":"Dis Colon Rectum"},{"key":"B2","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.ijsu.2019.12.012","article-title":"Enhanced recovery in proctology: a new setting for ERAS. A prospective study","volume":"75","author":"Catarci","year":"2020","journal-title":"Int J Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1007\/s00268-018-4844-y","article-title":"Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS\u00ae) society recommendations: 2018","volume":"43","author":"Gustafsson","year":"2019","journal-title":"World J Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1016\/j.clnu.2012.08.012","article-title":"Guidelines for perioperative care in elective rectal\/pelvic surgery: enhanced recovery after surgery (ERAS\u00ae) society recommendations","volume":"31","author":"Nygren","year":"2012","journal-title":"Clin Nutr"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1653","DOI":"10.1007\/s00384-016-2616-1","article-title":"Enhanced recovery pathway in proctological surgery: a systematic review","volume":"31","author":"Chemali","year":"2016","journal-title":"Int J Colorectal Dis"},{"key":"B6","doi-asserted-by":"publisher","first-page":"6835","DOI":"10.1038\/s41598-018-25127-5","article-title":"Application of enhanced recovery after surgery in patients with obstructing colorectal cancer undergoing emergency resection","volume":"8","author":"Shang","year":"2018","journal-title":"Sci Rep"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1631","DOI":"10.1007\/s00384-017-2880-7","article-title":"Short-term outcomes of a modified enhanced recovery after surgery protocol for patients undergoing emergency surgery for obstructive colorectal cancer","volume":"32","author":"Shida","year":"2017","journal-title":"Int J Colorectal Dis"},{"key":"B8","doi-asserted-by":"publisher","first-page":"418","DOI":"10.3390\/medicina58030418","article-title":"Strategies to reduce post-hemorrhoidectomy pain: a systematic review","volume":"58","author":"Lohsiriwat","year":"2022","journal-title":"Medicina (Kaunas)"},{"key":"B9","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1177\/1553350620946309","article-title":"Use of mobile health applications in surgical ERAS protocols: a systematic review","volume":"27","author":"Gani","year":"2020","journal-title":"Surg Innov"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e23927","DOI":"10.2196\/23927","article-title":"Mobile health for enhanced recovery after surgery programs: rapid review","volume":"9","author":"Wang","year":"2021","journal-title":"JMIR Mhealth Uhealth"},{"key":"B11","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1001\/jamasurg.2016.4952","article-title":"Enhanced recovery after surgery: a review","volume":"152","author":"Ljungqvist","year":"2017","journal-title":"JAMA Surg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1016\/S0140-6736(08)60357-8","article-title":"Fast-track colorectal surgery","volume":"371","author":"Kehlet","year":"2008","journal-title":"Lancet"},{"key":"B13","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1002\/bjs.9394","article-title":"Systematic review and meta-analysis of enhanced recovery programmes in surgical patients","volume":"101","author":"Nicholson","year":"2014","journal-title":"Br J Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"895598","DOI":"10.3389\/fsurg.2022.895598","article-title":"Strategies to reduce post-hemorrhoidectomy pain: a systematic review","volume":"9","author":"Milito","year":"2022","journal-title":"Front Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1007\/s00384-022-04236-4","article-title":"Parameters predicting postoperative pain and quality of life after hemorrhoidectomy","volume":"38","author":"Ko","year":"2023","journal-title":"Int J Colorectal Dis"},{"key":"B16","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1016\/S0002-9610(02)00866-8","article-title":"Multimodal strategies to improve surgical outcome","volume":"183","author":"Kehlet","year":"2002","journal-title":"Am J Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1097\/DCR.0000000000002636","article-title":"Implementation of a multimodal enhanced recovery protocol in elective anal Fistula and hemorrhoid surgery","volume":"67","author":"de Nardi","year":"2024","journal-title":"Dis Colon Rectum"},{"key":"B18","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1111\/anae.16093","article-title":"PROSPECT guideline for haemorrhoid surgery: a systematic review and procedure-specific postoperative pain management recommendations","volume":"78","year":"2023","journal-title":"Anaesthesia"},{"key":"B19","doi-asserted-by":"publisher","first-page":"708051","DOI":"10.3389\/fsurg.2021.708051","article-title":"Safety and effectiveness of tailored hemorrhoidectomy in an ambulatory setting: a prospective multicenter study","volume":"8","author":"Tomasicchio","year":"2021","journal-title":"Front Surg"},{"key":"B20","doi-asserted-by":"publisher","first-page":"254","DOI":"10.23736\/S0395-6116.23.05014-2","article-title":"A randomized, single-blind clinical study on multimodal long-acting analgesia after hemorrhoidectomy based on the ERAS concept","volume":"138","author":"Xu","year":"2023","journal-title":"Chirurgia (Bucur)"},{"key":"B21","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1016\/j.jviscsurg.2014.07.001","article-title":"Immediate removal of nasogastric tubes in emergency colorectal surgery is safe and feasible","volume":"151","author":"Venara","year":"2014","journal-title":"J Visc Surg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"883","DOI":"10.1111\/ans.13339","article-title":"Effects of an enhanced recovery after surgery program on emergency surgical patients","volume":"86","author":"Wisely","year":"2016","journal-title":"ANZ J Surg"},{"key":"B23","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1093\/bjs\/znab377","article-title":"Applying ERAS to same-day discharge colorectal surgery","volume":"109","author":"Balfour","year":"2022","journal-title":"Br J Surg"},{"key":"B24","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1097\/DCR.0000000000002645","article-title":"Implementation of a multimodal enhanced recovery protocol in ambulatory anorectal surgery: a randomized trial","volume":"67","author":"Yao","year":"2024","journal-title":"Dis Colon Rectum"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e32","DOI":"10.33661\/wjcs.2024.03.02.32","article-title":"Ambulatory anorectal surgery: unplanned healthcare utilization and predictors","volume":"3","author":"Talboom","year":"2024","journal-title":"World J Colorectal Surg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1016\/j.ygyno.2015.11.015","article-title":"Guidelines for pre- and intra-operative care in gynecologic\/oncology surgery: enhanced recovery after surgery (ERAS\u00ae) society recommendations\u2014part I","volume":"140","author":"Nelson","year":"2016","journal-title":"Gynecol Oncol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1016\/j.eururo.2016.02.051","article-title":"Enhanced recovery after urological surgery: a contemporary systematic review of outcomes, key elements, and research needs","volume":"70","author":"Azhar","year":"2016","journal-title":"Eur Urol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1002\/bjs.7716","article-title":"Early oral nutrition and mobilization after fast-track laparoscopic surgery","volume":"99","author":"Tolver","year":"2012","journal-title":"Br J Surg"},{"key":"B29","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/j.bpa.2020.10.002","article-title":"Enhanced recovery after surgery (ERAS) and its applicability for major orthopedic surgery: a review","volume":"35","author":"Wainwright","year":"2021","journal-title":"Best Pract Res Clin Anaesthesiol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1255","DOI":"10.1016\/j.suc.2018.07.012","article-title":"Patient engagement and compliance with enhanced recovery pathways","volume":"98","author":"Ljungqvist","year":"2018","journal-title":"Surg Clin North Am"},{"key":"B31","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1016\/j.clnu.2012.08.011","article-title":"Guidelines for perioperative care for pancreaticoduodenectomy: enhanced recovery after surgery (ERAS\u00ae) society recommendations","volume":"31","author":"Lassen","year":"2012","journal-title":"Clin Nutr"},{"key":"B32","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/s13037-024-00425-9","article-title":"Impact of \u201cenhanced recovery after surgery\u201d (ERAS) protocols vs. Traditional perioperative care on patient outcomes after colorectal surgery: a systematic review","volume":"19","author":"Kannan","year":"2025","journal-title":"Patient Saf Surg"},{"key":"B33","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1111\/aas.12651","article-title":"Enhanced recovery after surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice","volume":"60","author":"Feldheiser","year":"2016","journal-title":"Acta Anaesthesiol Scand"},{"key":"B34","doi-asserted-by":"publisher","first-page":"55","DOI":"10.29245\/2768-5365\/2025\/2.1157","article-title":"Evidence-based medicine underpinning the ERAS protocol in elective colorectal patients: a mini review","volume":"12","author":"Taplin","year":"2025","journal-title":"Anesthesiol Rev"},{"key":"B35","doi-asserted-by":"publisher","first-page":"2907","DOI":"10.3390\/curroncol31060209","article-title":"Outcomes before and after implementation of the ERAS protocol in colorectal cancer (CRC) patients: retrospective analysis from a population-based cancer registry","volume":"31","author":"Mangone","year":"2024","journal-title":"Curr Oncol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"6857","DOI":"10.2147\/JMDH.S433901","article-title":"A comprehensive evidence summary for pain assessment and management after hemorrhoidal surgery to inform clinical practice guidelines","volume":"18","author":"Zou","year":"2025","journal-title":"J Multidiscip Healthc"},{"key":"B37","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1186\/s13022-023-00411-5","article-title":"Implementation science in ERAS pathways: from evidence to practice","volume":"17","author":"Jones","year":"2023","journal-title":"Ann Surg Innov Res"},{"key":"B38","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1111\/codi.16502","article-title":"Long-term outcomes of enhanced recovery after surgery protocols in colorectal surgery: a systematic review","volume":"26","author":"Smith","year":"2024","journal-title":"Colorectal Dis"},{"key":"B39","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1016\/j.ijsu.2022.12.003","article-title":"Building international ERAS collaboratives: success factors from colorectal and urologic networks","volume":"109","author":"Aarts","year":"2023","journal-title":"Int J Surg"},{"key":"B40","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1007\/s00464-023-10009-4","article-title":"Digital health interventions in enhanced recovery after surgery programs: a meta-analysis","volume":"38","author":"Lee","year":"2024","journal-title":"Surg Endosc"},{"key":"B41","doi-asserted-by":"publisher","first-page":"e058822","DOI":"10.1136\/bmjopen-2021-058822","article-title":"Patient and public involvement in the development of enhanced recovery after surgery pathways: a systematic review","volume":"12","author":"Cunningham","year":"2022","journal-title":"BMJ Open"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1728394\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T06:47:17Z","timestamp":1770187637000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1728394\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,4]]},"references-count":41,"alternative-id":["10.3389\/fsurg.2026.1728394"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1728394","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,4]]},"article-number":"1728394"}}