ORIGINAL RESEARCH article
Front. Surg.
Sec. Visceral Surgery
This article is part of the Research TopicComplications in Major Abdominal Surgery: What to Expect and How to Deal with the Dark Side of SurgeryView all 5 articles
ERAS-based sequential olive oil–lactulose protocol in day-case laparoscopic inguinal hernia repair: a prospective comparison
Provisionally accepted
Xiaoqin Zhou1
Penghui Liu2Gengyu Tong Zhao3Deyan Bai1Wenqing Liu1Yueqian Zeng1Run Wan1Huijia Pan1
Jie Mao1,2*- 1Lanzhou University Second Hospital, Lanzhou, China
- 2Lanzhou University, Lanzhou, China
- 3Northeastern University, Boston, United States
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Objective: To investigate the effect of a sequential olive oil–lactulose approach within an enhanced recovery after surgery (ERAS) pathway on perioperative bowel management and postoperative recovery in patients undergoing day-case laparoscopic inguinal hernia repair. Methods: A total of 204 patients who underwent day-case laparoscopic inguinal hernia repair between June 2024 and June 2025 were divided into two groups according to bowel-preparation regimen: a study group (n=102) and a control group (n=102). The study group received a sequential regimen of olive oil and lactulose bowel preparation. The control group underwent traditional polyethylene glycol (PEG) bowel preparation. Both groups received standard ERAS measures. Outcomes compared between groups included bowel-preparation compliance and tolerance, gastrointestinal recovery (time to first flatus and defecation), time to first ambulation, length of hospital stay, incidence of complications, 24-h postoperative pain score by visual analogue scale (VAS), and discharge satisfaction. Results: The study group showed a significantly higher bowel-preparation compliance and tolerance than the control group (100% vs. 95.1%; 96.1% vs 68.6%; P < 0.05). Compared with the control group, the study group had shorter times to first flatus (14.2±3.1 h vs 22.7±5.3 h), first defecation (18.4±4.2 h vs 27.1±6.3 h), first ambulation (8.9±2.3 h vs 14.1±3.4 h), and length of hospital stay (1.8±0.6 d vs 2.7±0.9 d) (all P < 0.001). The incidences of abdominal distension (10.8% vs 70.6%), nausea/vomiting (7.8% vs 35.3%), and dry mouth (21.6% vs 44.1%) were lower in the study group (both P < 0.001), whereas the rate of urinary retention did not differ significantly between groups (P > 0.05). Postoperatively, the study group had lower VAS pain scores (2.1±0.7 vs 3.8±1.1) and higher satisfaction scores (4.3±0.7 vs 2.9±0.8) (both P < 0.001). Conclusions: Within the ERAS pathway, the sequential approach of olive oil and lactulose significantly improved bowel preparation compliance and tolerance in patients undergoing daytime laparoscopic inguinal hernia repair. This approach accelerated gastrointestinal function recovery, shortened hospital stays, reduced complication rates, alleviated postoperative pain, and enhanced patient satisfaction.
Keywords: Bowel preparation, Day-case surgery, Enhanced recovery after surgery (ERAS), inguinal hernia, Lactulose, olive oil
Received: 27 Oct 2025; Accepted: 26 Jan 2026.
Copyright: © 2026 Zhou, Liu, Tong Zhao, Bai, Liu, Zeng, Wan, Pan and Mao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jie Mao
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