Annals of Pediatric Surgery

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Enhanced recovery protocols versus traditional methods after resection and reanastomosis in gastrointestinal surgery in pediatric patients

Mohamed Fathy, Mohamed M. Khedre, Mohamed A.M. Nagaty, Naser M. Zaghloul


Background Enhanced recovery after surgery (ERAS) is a group of changes in perioperative care that represent a fundamental shift from the traditional management of the gastrointestinal (GI) surgical patient.
Objective To compare the results of applying enhanced recovery after GI resection in children versus the traditional methods.
Patients and methods This prospective study included 60 patients who underwent GI resectional surgery between February 2016 and February 2017 at our institution. The patients were divided into two groups: group A (30 patients) was managed with ERAS protocol and group B (30 patients) was managed with traditional methods. All the patients underwent standard hand-sewn technique of GI resection reanastomosis. The protocol of ERAS included no routine nasogastric tube, early diet advancement, minimization of narcotic analgesics, early ambulation, and physical rehabilitation.
Results The most frequent cause of GI resection reanastomosis surgery was intussusception (33.3% in group A and 36.7% in group B). Patients in group A had a significant lower frequencies of postoperative fever (33.3 vs. 66.7%, P<0.01) and chest infection (26.7 vs. 60%, P<0.01). Moreover, group A showed a significant shorter postoperative length of hospital stay (4 ± 1.2 days in group A vs. 7.1 ±2.05 days in group B, P<0.001).
Conclusion Adopting ERAS protocol for resectional GI surgery in pediatric patients should be encouraged as it is results in lower incidences of postoperative fever and chest infection and is associated with less postoperative length of hospital stay.

Keywords: enhanced recovery after surgery, enteral nutrition, gastrointestinal surgery, length of hospital stay, pediatric surgery
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