Transcutaneous electrical acupoint stimulation in enhanced recovery after abdominal surgery: an evidence-based perspective

Dear Editor, In recent years, Enhanced Recovery after Surgery (ERAS) protocols have revolutionized perioperative care in abdominal surgery. Despite advances, postoperative gastrointestinal dysfunction remains a significant clinical challenge, particularly following laparoscopic procedures where pneumoperitoneum can impair gastrointestinal motility[1]. A recent systematic review and meta-analysis by Wu et al published in this journal provides compelling evidence supporting transcutaneous electrical acupoint stimulation (TEAS) as an effective adjunct in ERAS protocols[2]. The analysis of 16 randomized controlled trials (n = 2300) demonstrated that TEAS significantly accelerates gastrointestinal recovery, reducing time to first flatus and defecation while promoting earlier oral intake resumption. Furthermore, TEAS was associated with decreased incidence of postoperative nausea and vomiting, reduced pain scores, shorter hospital stays, and lower overall hospitalization costs. The therapeutic mechanisms of TEAS appear multifaceted. Evidence suggests it modulates autonomic nervous system activity, enhancing parasympathetic tone while reducing sympathetic overactivity, thereby promoting gastrointestinal motility[3]. Additionally, TEAS demonstrates anti-inflammatory properties through downregulation of pro-inflammatory cytokines and upregulation of anti-inflammatory mediators, potentially mitigating inflammation-induced gastrointestinal dysfunction[4]. These physiological effects, combined with its non-invasive nature and excellent safety profile, make TEAS particularly suitable for integration into multimodal ERAS pathways. However, several limitations merit consideration. The predominance of Chinese studies may affect generalizability to other populations, while heterogeneity in TEAS protocols (acupoint selection, stimulation parameters, timing) hampers standardization[2]. Moreover, variable reporting of ERAS components across studies complicates isolation of TEAS-specific effects. Future directions should prioritize multicenter trials in diverse populations to validate these findings internationally[5]. Research should establish optimal TEAS parameters through dose–response studies and investigate cost-effectiveness within standardized ERAS pathways[6]. Mechanistic studies incorporating physiological monitoring could further elucidate TEAS’s mode of action and identify predictive biomarkers of response. In conclusion, current evidence strongly supports TEAS as a valuable adjunct in abdominal surgery ERAS protocols. By accelerating gastrointestinal recovery and reducing complications, TEAS aligns perfectly with ERAS objectives of improving outcomes while optimizing resource utilization. As research advances toward protocol standardization and mechanistic understanding, TEAS is poised to become a new option of evidence-based perioperative care. We confirm that our article adheres to the TITAN Guidelines 2025, as evidenced by the completed TITAN Guideline Checklist 2025[7]. The manuscript is an original work and has not been submitted or is under consideration for publication in any other journal. All the authors have seen and given final approval of the submitted manuscript. Consent This study did not involve patient identifiable information and no additional consent was required.