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Robot-Assisted Laparoscopic Splenectomy In Children: A Case Report with Literature Review
Published on: March 27, 2026
Efficacy and safety of ERAS protocols in pediatric laparoscopic appendectomy: a systematic review and meta-analysis
Di Wang1, Rongkun Zhu1, Xiaoxuan Ma1
1Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.
Insights
Enhanced recovery after surgery (ERAS) protocols significantly improve outcomes for pediatric laparoscopic appendectomy. ERAS reduces hospital stay, pain, and complications, accelerating recovery in children.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Enhanced Recovery Protocols
Background:
- Acute appendicitis is a common pediatric surgical emergency.
- Laparoscopic appendectomy is the standard treatment.
- Enhanced Recovery After Surgery (ERAS) protocols show promise but are less established in pediatric emergency surgery.
Purpose of the Study:
- To systematically evaluate the efficacy and safety of ERAS protocols versus traditional care for pediatric laparoscopic appendectomy.
- To assess the impact on key postoperative outcomes.
Main Methods:
- Systematic literature search of major databases (PubMed, Web of Science, Cochrane, Embase, CNKI) up to March 2026.
- Inclusion of randomized controlled trials (RCTs) comparing ERAS with traditional care in pediatric patients.
- Meta-analysis of primary outcomes (hospital stay, time to first flatus) and secondary outcomes (pain, complications).
Main Results:
- Eight RCTs involving 1,135 children were analyzed.
- ERAS significantly reduced postoperative hospital stay by 2.04 days.
- ERAS accelerated time to first flatus by 7.51 hours, reduced pain scores by 1.70 (VAS), and lowered complication risk by 71% (RR: 0.29).
Conclusions:
- ERAS protocols are effective and safe for pediatric laparoscopic appendectomy.
- They significantly improve recovery, reduce pain, and lower complication rates.
- Broader adoption of ERAS in pediatric emergency surgery is recommended, with potential for day-surgery pathways.
Background:
Acute appendicitis is the most common surgical emergency in children, and laparoscopic appendectomy has become the standard of care. Enhanced recovery after surgery (ERAS) protocols have demonstrated significant benefits in adult populations, but their application in pediatric emergency surgery remains less established.
Objective:
To systematically evaluate the efficacy and safety of ERAS protocols compared with traditional perioperative care in children undergoing laparoscopic appendectomy for acute appendicitis.
Methods:
A systematic search was conducted in PubMed, Web of Science, Cochrane Library, Embase, and China National Knowledge Infrastructure (CNKI) from inception to March 2026. Randomized controlled trials (RCTs) comparing ERAS protocols with traditional perioperative care in pediatric patients undergoing laparoscopic appendectomy were included. The primary outcomes were postoperative hospital stay and time to first flatus; secondary outcomes included postoperative pain scores and total complications. Meta-analysis was performed using RevMan 5.4, with mean differences (MDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes. Heterogeneity was assessed using the I2 statistic.
Results:
Eight RCTs comprising 1,135 pediatric patients were included. ERAS protocols significantly reduced postoperative hospital stay (MD: -2.04 days, 95% CI: -2.74 to -1.34, P < 0.00001, I2 = 96%), accelerated time to first flatus (MD: -7.51 h, 95% CI: -11.00 to -4.03, P < 0.0001, I2 = 99%), alleviated postoperative pain (MD: -1.70 on VAS 0-10, 95% CI: -2.72 to -0.68, P = 0.001, I2 = 99%), and reduced the risk of total postoperative complications (RR: 0.29, 95% CI: 0.15 to 0.58, P = 0.03, I2 = 54%). Sensitivity analyses confirmed the robustness of the findings.
Conclusions:
ERAS protocols are effective and safe for children undergoing laparoscopic appendectomy, significantly reducing hospital stay, accelerating gastrointestinal recovery, alleviating postoperative pain, and lowering complication risk. These findings support broader adoption of ERAS in pediatric emergency surgical practice, while acknowledging that some components may already be integrated into routine care in certain settings, and that further optimization through day-surgery pathways is warranted for uncomplicated cases.
