Post-surgical diets in the ERAS protocol: D-ERAS scoping review

The Enhanced Recovery After Surgery (ERAS) program emphasizes early oral feeding (EOF) as a key component for faster patient recovery. ERAS guidelines recommend resuming oral feeding within 24 h after surgery, but without specification on diet progression, portion sizes, and macronutrient targets. This scoping review aims to analyze existing postoperative oral feeding protocols (OFPs) across various abdominal surgical procedures. A literature search was conducted via PubMed and Scopus. Articles were assessed for eligibility based on prespecified inclusion criteria. The data were synthesized, and the results were reported and discussed thematically. Sixty-eight articles were included (24 for esophageal and/or gastric surgery, 16 for hepatobiliary or pancreatic, 22 for colorectal, 6 for urologic or gynecologic surgery). Our review found that in many studies oral feeding started much later than recommended by the ERAS guidelines. For colorectal surgery, although a low-residue diet is preferred over clear liquids, only few studies prescribed a solid diet immediately postoperatively. Similarly, for gastric and upper GI surgery, where early oral feeding is encouraged, most studies started with liquids and progressed slowly. In gynecologic and urologic surgeries, although early feeding is safe and recommended, alternative approaches were found. This review analyzed dietary protocols within ERAS pathways and identified significant inconsistencies and non-adherence to the ERAS recommendations. A major issue was the lack of standardized terminology and detailed descriptions of diet composition (energy, nutrients, food types, meal frequency) across studies.