Comparative study: enhanced recovery after surgery for acute cholecystitis undergoing laparoscopic cholecystectomy in a tertiary centre of rural tribal belt of western Maharashtra

Background & objectives: Enhanced Recovery After Surgery (ERAS) pathways aim to minimise surgical stress, promote faster return of function, shorten hospital stay. While ERAS has been studied extensively in high-resource centres, evidence from rural tribal tertiary care hospitals is limited. This study compared ERAS with conventional perioperative care in patients undergoing laparoscopic cholecystectomy (LC) for acute cholecystitis. Methods: A prospective comparative study was conducted at rural tertiary hospital in western Maharashtra between January 2024 and July 2025. Adults aged 18–60 years with ASA grade I–III and Tokyo Guidelines grade I–II acute cholecystitis were included. Patients received either ERAS-based care or conventional management. Outcomes assessed included postoperative length of stay (LOS), time to oral intake and mobilisation, pain scores, opioid use, complications (≥Clavien–Dindo II), 30-day readmissions. Results: Of 126 enrolled patients, 63 were assigned to each group. ERAS patients had a shorter LOS (median 3.0 d (IQR 2–3] vs. 4.0 d (IQR 4–5] ; p<0.001), earlier oral intake (8 h (IQR 7–8] vs. 24 h (IQR 20–26] ; p<0.001), quicker mobilisation (7 h (IQR 6–8] vs. 24 h (IQR 20–26] ; p<0.001). Pain scores and opioid requirements were lower in ERAS group (p<0.001). Rates of complications and readmissions were comparable (p=0.47). Interpretation & conclusions: ERAS-based perioperative management for LC in acute cholecystitis is feasible in rural and tribal settings. Enabling earlier recovery, reduces opioid use, maintains safety outcomes, supporting its wider adoption in resource-limited hospitals.