Is enhanced recovery after surgery protocol has high value in after laparoscopic myomectomy?

With great interest, we carefully read the meta-analysis written by Chen and colleagues entitled “Effect of the enhanced recovery after surgery protocol on recovery after laparoscopic myomectomy: a systematic review and meta-analysis” (1), recently published in Gland Surgery.

Meta analysis revealed that application of enhanced recovery after surgery (ERAS) protocol can shorten the first exhaust time, hospital stay and reduce the rate of postoperative complications and readmission. However, several limitations need to raise.

To begin with, there are some defects in the literature search process. First, the investigators did not provide us manual search protocol and detailed information of search strategy. We are worried that their search strategy cannot find all articles on this topic. Furthermore, only three electronic databases (PubMed, Medline, and Ovid) were systematically searched for English studies and two electronic databases (China National Knowledge Network and Wanfang Data) for eligible studies. Thus, to make this meta-analysis more convincing, the authors are suggested to use foreign electronic database like Scopus, Web of Science, Cochrane Library, and Chinese electronic database including China Biology Medicine DISC and China Science and Technology Journal Database need to search for eligible studies with a comprehensive search protocol.

Secondly, in the results section, the heterogeneity is significant high. In order to explore potential sources of heterogeneity, meta regression and subgroup analyses are necessary to carry out. The covariates such as age (>40 versus <40 years), year of publication (2010–2015 versus 2016–2021), country (China versus not China) and sample size (>120 versus <120 cases) should be considered when performing meta regression and subgroup analysis.

Lastly, there is a defect in this study. In the results section, the authors claimed that no publication bias in the included studies in Fig. 8. However, funnel plot was used to evaluate publication bias in more than 10 articles. Sensitivity analysis is necessary for meta-analysis, we noticed that the author didn’t perform sensitivity analysis to make the results more convincing.

The article’s supplementary files as