Related Experiment Video
Updated: Jul 29, 2025
Modified Single-Loop Reconstruction for Pancreaticoduodenectomy
Published on: September 28, 2019
Enhanced recovery management in pediatric pyeloplasty: outcomes in a single institution and tips for improvement
Jiannan He1, Huajian Lai1, Tianyou Zhang1
1Department of Urology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Yuancun Erheng Road 26, Guangzhou, 510655, Guangdong, China.
Insights
Enhanced recovery after surgery (ERAS) for pediatric laparoscopic pyeloplasty (LP) significantly reduced hospital stays. This approach to pediatric LP shows promise for improving patient recovery without increasing readmissions.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Enhanced Recovery After Surgery Protocols
Background:
- Laparoscopic pyeloplasty (LP) is a standard procedure for pediatric ureteropelvic junction obstruction (UPJO).
- Enhanced Recovery After Surgery (ERAS) protocols aim to optimize patient recovery and reduce hospital stay.
- Application of ERAS in pediatric surgical procedures is evolving.
Purpose of the Study:
- To evaluate the implementation and outcomes of a comprehensive ERAS regimen for pediatric patients undergoing LP.
- To guide the practice of ERAS in the context of pediatric laparoscopic pyeloplasty.
Main Methods:
- A prospective, twenty-point ERAS protocol was implemented for pediatric UPJO patients undergoing modified LP.
- Data from 75 patients (ages 0-14) between 2018-2021 were retrospectively analyzed.
- Key outcomes included postoperative length of stay (POS), readmission rates, operation time, and blood loss.
Main Results:
- The mean POS was 2.4 days, which is shorter than reported in recent Chinese studies.
- No patients required redo surgery; 8% experienced restenosis, successfully treated with balloon dilatation.
- No external drainage, sacral anesthesia, and early catheter removal were independently associated with POS ≤ 2 days.
Conclusions:
- The ERAS protocol for pediatric LP effectively shortened hospital stays without increasing readmission rates.
- Surgical techniques, drainage management, and analgesia are crucial for further ERAS optimization in pediatric pyeloplasty.
- Encouraging the adoption of ERAS for pediatric pyeloplasty is recommended.
Objective:
We report the application of enhanced recovery after surgery (ERAS) regimens to pediatric patients undergoing laparoscopic pyeloplasty (LP), aiming to guide the practice of ERAS in pediatric LP.
Methods:
From October 2018, we prospectively implemented a twenty-point ERAS regimen, including a modified LP procedure, for pediatric UPJO patients in a single institution. Data from 2018 to 2021 were collected and analyzed retrospectively. The variables gathered included: demographics, preoperative details and recovery elements. Outcomes were postoperative length of stay (POS), readmission rate, operation time and blood loss.
Results:
A total of 75 pediatric patients (0-14 years) were included. The mean POS was 2.4 ± 1.4 days, shorter than that in recent studies in China (3.3 ± 1.4 days, 6 (3-16) days). None were redo, and six restenosis (8%) were improved after treatment with ureteral balloon dilatation. The mean operation time was 257.9 ± 54.4 min, and blood loss was 11.8 ± 10.0 ml. In the univariable analysis and multivariable analysis, no external drainage, sacral anesthesia, and withdrawal of the catheter on day one were independently associated with a POS of ≤ 2 d (p < 0.05).
Conclusion:
The implementation of this ERAS protocol for pediatric LP has resulted in a shorter length of stay without a higher readmission rate. Surgery techniques, drainage management and analgesia are the key to further improvement. ERAS for pediatric pyeloplasty should be encouraged.
