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Updated: Sep 30, 2025
Author Spotlight: Cutting-Edge Robotic Heller Myotomy Protocol for Treatment of Achalasia
Published on: February 16, 2024
Implementation of enhanced recovery protocols reduces opioid use in pediatric laparoscopic Heller myotomy surgery
Olivia A Keane1, Goeto Dantes1, Srinivas Emani2
1Department of Surgery, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322, United States.
Insights
Enhanced recovery protocols (ERPs) significantly reduce opioid use in pediatric achalasia patients undergoing Heller myotomy. This approach improves surgical care quality and patient outcomes post-procedure.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Enhanced Recovery Protocols
Background:
- Enhanced recovery protocols (ERPs) standardize and improve surgical care quality in adults.
- The study investigates the impact of pediatric-specific ERPs on laparoscopic Heller myotomy outcomes in children.
Purpose of the Study:
- To retrospectively compare surgical outcomes in children before and after the implementation of enhanced recovery protocols (ERPs).
- To evaluate the effectiveness of ERPs in reducing opioid consumption and length of stay for pediatric achalasia patients.
Main Methods:
- A pediatric-specific ERP was implemented in July 2017 across two pediatric surgery centers.
- Outcomes were compared between a pre-ERP cohort (8 patients, July 2014-July 2017) and a post-ERP cohort (14 patients, 2017-2020).
- Key outcomes assessed included in-hospital and discharge opioid use, time to regular diet, length of stay (LOS), and readmissions.
Main Results:
- The post-ERP cohort showed a significant reduction in opioid use during admission (mean morphine equivalent 1.97 mg vs. 4.50 mg).
- 57% of post-ERP patients received no opioids during admission, compared to 25% pre-ERP.
- Discharge opioid prescriptions decreased significantly, with only 7.14% of post-ERP patients receiving them versus 75% pre-ERP.
Conclusions:
- Enhanced recovery protocols (ERPs) are safe and effective for pediatric laparoscopic Heller myotomy.
- ERPs lead to a notable reduction in opioid use during hospital admission and at discharge for children undergoing this procedure.
Background:
Enhanced recovery protocols (ERPs) are effective means of standardizing and improving the quality of surgical care in adults. Our purpose was to retrospectively compare outcomes before and after implementation of ERPs in children undergoing laparoscopic Heller myotomy for achalasia.
Methods:
A pediatric-specific ERP was used for children undergoing laparoscopic Heller myotomy starting July 2017 at two pediatric surgery centers within a single metropolitan healthcare system. A retrospective review of 8 patients undergoing Heller myotomies between July 2014 and July 2017 was performed as a control. This cohort was compared to 14 patients managed post-ERP implementation (2017-2020). Outcomes of interest investigated included opioid use during admission, narcotics at discharge, time to regular diet, length of stay (LOS), and readmissions.
Results:
There was a significant decrease in opioid use both while in the hospital and at time of discharge. Mean morphine equivalent use was 4.50 mg in the pre-ERP cohort and 1.97 mg in the post-ERP cohort. Furthermore, 8 out of 14 (57%) patients in the post-ERP cohort received no opioids during the admission compared with only 2 out of 8 (25%) patients in the pre-ERP cohort. Only 1 out of 14 (7.14%) patients in the post-ERP cohort was discharged with a prescription for opioid medication while 6 out of 8 (75%) in the pre-ERP cohort were discharged with an opiate prescription.
Conclusions:
The use of ERP in children undergoing laparoscopic Heller myotomy surgery is safe and effective and leads to a reduction in opioid use during admission and at discharge.
Levels Of Evidence:
Level III.
