# ERAS-based sequential olive oil-lactulose protocol in day-case laparoscopic inguinal hernia repair: a prospective comparison

## TL;DR

A new protocol using olive oil and lactulose in hernia surgery recovery improves patient comfort, speeds recovery, and reduces hospital stays.

## Contribution

A sequential olive oil–lactulose bowel preparation protocol is introduced and shown to enhance ERAS outcomes in laparoscopic hernia repair.

## Key findings

- The olive oil–lactulose group had higher bowel-preparation compliance and tolerance compared to the PEG group.
- Patients in the study group experienced faster gastrointestinal recovery and shorter hospital stays.
- The new protocol reduced postoperative complications like nausea and abdominal distension.

## Abstract

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.

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.

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).

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.