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Enhanced recovery after surgery protocol implementation in pediatric Meckel's diverticulum resection: A clinical
Kai Zhu1, Xiao Zhang1, Yan Li1
1Department of Pediatric Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China.
Insights
Enhanced Recovery After Surgery (ERAS) protocols significantly improve recovery for pediatric laparoscopic Meckel's diverticulum resections. ERAS reduces hospital stays and pain while enhancing clinical outcomes in children.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Enhanced Recovery After Surgery Protocols
Background:
- Enhanced Recovery After Surgery (ERAS) guidelines are established for adults but lack pediatric-specific protocols.
- Pediatric laparoscopic Meckel's diverticulum resection is a common procedure where ERAS could optimize care.
Purpose of the Study:
- To evaluate the clinical outcomes of ERAS protocols in pediatric laparoscopic Meckel's diverticulum resection.
- To compare perioperative recovery parameters between traditional care and ERAS groups.
Main Methods:
- Retrospective cohort study of 78 pediatric patients (January 2017-March 2025).
- Comparison of a traditional care group (n=38) with an ERAS protocol group (n=40).
- Analysis of clinical recovery parameters and laboratory markers.
Main Results:
- ERAS group showed significantly shorter postoperative length of stay (7.55 vs 10.40 days).
- ERAS implementation led to reduced IV fluid, faster GI recovery, lower pain scores, and earlier enteral nutrition.
- Improved inflammatory markers and glycemic control were observed in the ERAS group.
Conclusions:
- ERAS protocols safely optimize recovery in pediatric laparoscopic Meckel's diverticulum resection.
- Adoption of ERAS in pediatric intestinal surgery is supported by improved pain management and clinical outcomes.
Background:
Enhanced recovery after surgery (ERAS) guidelines have been established for multiple types of adult surgeries. However, ERAS guidelines tailored to pediatric surgeries remain to be developed.
Aim:
To evaluate the clinical outcomes of ERAS protocols in pediatric laparoscopic Meckel's diverticulum resection.
Methods:
This retrospective cohort study analyzed 78 consecutive pediatric cases treated between January 2017 and March 2025. Patients were divided into: Traditional care group (n = 38): January 2017-December 2020; ERAS protocol group (n = 40): January 2021-March 2025. We compared perioperative outcomes, including clinical recovery parameters and laboratory markers, to assess protocol efficacy.
Results:
All procedures were completed laparoscopically by the same surgical team without conversion. Baseline characteristics, including demographics, diverticulum location, and intraoperative parameters (operative time, blood loss), were comparable between groups (all P > 0.05). The ERAS protocol demonstrated significantly shorter postoperative length of stay (7.55 ± 1.52 days vs 10.40 ± 3.59 days, P < 0.001) while complication rates were numerically lower in the ERAS group (17.50% vs 13.16%, P = 0.595). Additional benefits of ERAS implementation included: Reduced intravenous fluid requirements (5.00 mL/kg/hour vs 8.00 mL/kg/hour), accelerated gastrointestinal recovery (first flatus: 2.00 days vs 3.00 days), lower pain scores (P < 0.001), earlier total enteral nutrition achievement (5.00 days vs 6.50 days) and shorter intravenous therapy duration (6.00 days vs 8.00 days; all P < 0.001). ERAS patients also showed reduced drainage utilization (P < 0.05) and improved inflammatory marker profiles postoperatively [neutrophils: (5.98 ± 2.02) × 109/L vs (8.01 ± 3.98) × 109/L]; median C-reactive protein: 13.6 mg/L 7 vs 19.63 mg/L). Glycemic control was superior in the ERAS group despite higher induction levels (both P < 0.05). Parental satisfaction (92.50% vs 86.84%) and 30-day readmission rates (2.50% vs 2.63%) showed no significant differences.
Conclusion:
ERAS protocols safely optimize recovery in children undergoing laparoscopic Meckel's diverticulum resection, significantly reducing length of stay while improving pain management and overall clinical outcomes. These findings support the adoption of ERAS in pediatric intestinal surgery.
