Fast Track versus Conventional Perioperative Care Protocols in Paediatric Intestinal Stoma Closure ‒ A Randomised
Tanzil Farhad1, Md Khurshid Alam Sarwar, Mohammad Zonaid Chowdhury
1Department of Paediatric Surgery, Chittagong Medical College and Hospital, Chittagong, Bangladesh.
Insights
Fast-track (FT) surgery is safe and effective for paediatric intestinal stoma closure, showing comparable outcomes to conventional care. This approach can minimize unnecessary interventions in pediatric surgical patients.
Area of Science:
- Pediatric Surgery
- Surgical Innovation
- Enhanced Recovery Pathways
Background:
- Fast-track (FT) surgery applicability in pediatric surgery remains unclear.
- Assessing FT protocols against conventional care for pediatric intestinal stoma closure is crucial.
Purpose of the Study:
- To compare outcomes between FT and conventional perioperative care in pediatric intestinal stoma closure.
- To evaluate the safety of FT protocols for future pediatric surgical applications.
Main Methods:
- Prospective randomized study of 26 pediatric patients undergoing intestinal stoma closure.
- Group A: Conventional care; Group B: FT protocol (minimal fasting, no bowel prep, early feeding/mobilization, non-opioid analgesia).
- Comparison of post-operative hospital stay and complication rates between groups.
Main Results:
- No significant differences in anastomotic leak, wound infection, or dehiscence between groups.
- Similar post-operative length of stay (median 5 days vs. 6 days) and time to bowel function (median 2 days).
- FT group showed 0% wound infection and dehiscence compared to 7.7% in the conventional group.
Conclusions:
- Fast-track surgery is comparable to conventional methods for pediatric intestinal stoma closure.
- FT protocols can reduce unnecessary interventions without compromising patient safety.
- The study supports the safe application of FT surgery in pediatric surgical settings.
Background:
It is still unclear to what extent fast-track (FT) surgery is applicable in paediatric surgery. The aim of the study was to compare the outcome between FT and conventional perioperative care protocols in paediatric intestinal stoma closure to assess the safety for future application.
Materials And Methods:
This study was a prospective randomised study. Twenty-six paediatric patients who underwent intestinal stoma closure from December 2019 to March 2021 were divided into two groups: group A, conventional methods and Group B FT protocol. The FT protocol included minimal pre-operative fasting, no pre-operative bowel preparation, no routine intraoperative use of nasogastric tube, drain tube, urinary catheter, early post-operative enteral feeding, early mobilisation, non-opioid analgesics and prophylactic use of anti-emetic. Total length of post-operative hospital stays and complications between these two groups were compared.
Results:
No significant differences were found between the two groups regarding anastomotic leak (nil in both groups), wound infection (7.7% in Group A vs. 0% in Group B; P = 1.0) and wound dehiscence (7.7% in Group A vs. 0% in Group B; P = 1.0). No significant differences were found in post-operative length of stay (median 5, interquartile range [IQR] 4-9 in Group A and median 6, IQR 4-7 in Group B, P = 0.549) and time to appearance of bowel function (passage of stool) (median 2 days in both groups; P = 0.978).
Conclusions:
FT surgery was comparable to the conventional method in terms of complication and thus can reduce unnecessary interventions.
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