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Safety and Feasibility of Enhanced Recovery after Surgery in Pediatric Colostomy Closure
Vidya M Saravagol1, Anand Alladi1, B Mamatha1
1Department of Paediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
Insights
The enhanced recovery after surgery (ERAS) protocol is safe and feasible for pediatric colostomy closure. This approach leads to shorter hospital stays and cost savings with no increased complications.
Area of Science:
- Pediatric Surgery
- Surgical Protocols
Background:
- Colostomy closure is a common procedure in pediatric surgery.
- Enhanced recovery after surgery (ERAS) protocols aim to optimize patient recovery and reduce hospital stay.
Purpose of the Study:
- To evaluate the safety and feasibility of implementing an ERAS protocol for pediatric colostomy closure.
- To assess the impact of the ERAS protocol on patient outcomes, including hospital stay and complications.
Main Methods:
- Retrospective observational study of 90 pediatric patients undergoing colostomy closure over a 10-year period.
- Data collected from electronic medical records and follow-up calls, analyzing parameters like age, diagnosis, luminal discrepancy, feeding time, hospital stay, and complications.
- ERAS protocol included no bowel prep, no nasogastric tube, early oral feeds, single-dose antibiotics, and opioid avoidance.
Main Results:
- The majority of patients (90) had colostomy closure, with most cases related to anorectal malformation.
- Early feeding (within 2 days) was achieved in 79 patients, and a short postoperative hospital stay (2-3 days) was observed in 62 patients.
- Complications included surgical site infection in 6 patients and fecal fistula in 4 patients, with most managed conservatively.
Conclusions:
- The ERAS protocol for pediatric colostomy closure is safe and feasible.
- Implementation of the ERAS protocol resulted in reduced hospital stays and was cost-effective.
- The protocol facilitated early recovery without an increase in complications.
Aims:
To study the safety and feasibility of enhanced recovery after surgery (ERAS) protocol in pediatric colostomy closure.
Materials And Methods:
Retrospective observational study of children who underwent colostomy closure. Data were collected from the electronic medical records and telephonic follow-up calls of patients from October 2013 to October 2023, in the Department of Pediatric Surgery of a Tertiary level Medical College. The parameters obtained were age, gender, type of stoma, primary diagnosis, discrepancy in luminal diameters, time to reach full feeds, postoperative hospital stay, and complications. The protocol followed for colostomy closure included the following-no bowel preparation or nasogastric tube, no overnight fasting, single dose of antibiotic prophylaxis, avoiding opioids, packing proximal stoma till mobilization and starting early oral feeds postoperatively. The continuous parameters were expressed as mean ± standard deviation or median (range) while the descriptive parameters were expressed as number and percentage.
Results:
A total of 90 patients were included in the study. Most of the patients had colostomy for anorectal malformation. Five of them had significant luminal discrepancy of 4 or more times. Full feeds were reached within 2 days in 79 patients. Postoperative hospital stay was 2-3 days in 62 patients. Six patients stayed for more than 5 days, due to complications requiring further management. We noted surgical site infection in 6 patients all of whom were managed with regular wound dressings and fecal fistula in 4 cases, two of which resolved spontaneously.
Conclusion:
ERAS protocol in colostomy closure reduces the hospital stay and is cost effective, with early recovery and no added complications.
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