Enhanced Recovery After Gastrointestinal Surgery (ERAS) in Pediatric Patients: a Systematic Review and Meta-analysis

Arena, Salvatore; Fabrizio, Donatella Di; Impellizzeri, Pietro; Gandullia, Paolo; Mattioli, Girolamo; Romeo, Carmelo

doi:10.1007/s11605-021-05053-7

Cited by 51 publications

(40 citation statements)

References 37 publications

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“…In 2016, a literature review reported only five studies examining the impact of ERP in all pediatric surgical patients [ 4 ]. By 2022, the number of studies had grown to sixteen, signaling interest in the field [ 6 , 30 ]. Currently, the ERAS Society has only one pediatric protocol focusing on neonatal bowel surgery but evidence is limited [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

The Development of an Enhanced Recovery Protocol for Kasai Portoenterostomy

et al. 2022

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Balancing post-operative adequate pain control, respiratory depression, and return of bowel function can be particularly challenging in infants receiving the Kasai procedure (hepatoportoenterostomy). We performed a retrospective chart review of all patients who underwent the Kasai procedure from a single surgeon at Children’s Healthcare of Atlanta from 1 January 2018, to 1 September 2022. 12 patients received the Kasai procedure within the study period. Average weight was 4.47 kg and average age was 7.4 weeks. Most patients received multimodal pain management including dexmedetomidine and/or ketorolac along with intravenous opioids. A balance of colloid and crystalloids were used for all patients; 57% received blood products as well. All patients were extubated in the OR and transferred to the general surgical floor without complications. Return of bowel function occurred in all patients by POD2, and enteral feeds were started by POD3. One patient had a presumed opioid overdose while admitted requiring a rapid response and brief oxygen supplementation. Simultaneously optimizing pain control, respiratory safety, and bowel function is possible in infants receiving the Kasai procedure. Based on our experience and the current pediatric literature, we propose an enhanced recovery protocol to improve patient outcomes in this fragile population. Larger, prospective studies implementing an enhanced recovery protocol in the Kasai population are required for stronger evidence and recommendations.

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Section: Discussionmentioning

confidence: 99%

The Development of an Enhanced Recovery Protocol for Kasai Portoenterostomy

et al. 2022

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“…A meta-analysis of the ERAS protocol in pediatric patients undergoing gastrointestinal surgery revealed that ERAS hastened the recovery of gastrointestinal function, and decreased peri-operative infusions and hospital stay. [29] We applied the ERAS protocol to every patient successfully. Our discharge rate within the rst postoperative day was 93.5%.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Surgery for Orchidopexy in Children with Cryptorchidism: Reducing the Need for an Inguinal Incision

Guo

Zhong

et al. 2022

Preprint

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Purpose: This study was to summarize our experience with minimally invasive surgery in the treatment of boys with cryptorchidism.Methods: A retrospective study of laparoscopic orchidopexy (group A = 29) and laparoscopic ligation of the patent processus vaginalis (PPV) plus trans-scrotal orchidopexy (group B = 78) was conducted between July 2018 and July 2021.Results: Seven patients had to be converted to trans-inguinal surgery in group A. In the remaining 22 patients, successful laparoscopic orchidopexy was performed. The discharge rate on post-operative day 1 was 93.5%, but there was no difference between the two groups (p > 0.05). The operative time of group B in bilateral cryptorchidism was significantly shorter than group A (p < 0.05), but there was no difference in the case of unilateral cryptorchidism (p > 0.05). There was no testicular retraction, testicular atrophy, inguinal hernia, or hydrocele during the follow-up period in both groups. Although the incidence of post-operative fever and poor wound healing in group B was higher than in group A, this was not statistically significant (p > 0.05).Conclusion: Laparoscopic and trans-scrotal surgery are safe and effective methods for patients with cryptorchidism, reducing the need for trans-inguinal surgery.

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“…In pediatric thoracoscopic surgery, hypothermia is prone to occur, mainly due to the loss of the behavioral regulation mechanism in children during general anesthesia and the inhibition of the central regulation system because of temporary hypogenesis of body temperature by anesthetics. 16 Improper intraoperative thermal insulation will lead to adverse events such as hypothermia and chills. Because of the incomplete development of their body temperature regulation center, children have poor ability to regulate body temperature and are greatly affected by the external environment.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A single‐center study of thoracoscopic surgery in the treatment of pediatric mediastinal neurogenic tumors

et al. 2022

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Objective To study the feasibility, safety, and efficacy of thoracoscopic surgery in the treatment of pediatric mediastinal neurogenic tumors, and summarize the treatment experiences and surgical skills. Methods A single‐center retrospective analysis of 37 patients with pediatric mediastinal neurogenic tumors was conducted. Clinical charactersistics and postoperative complications were all analyzed. Results All the operations were successfully completed. There was no statistically significant difference in tumor diameter between the two groups ( p > 0.05). The open surgery group had an average operation time of 96.5 ± 32.38 min, while the thoracoscopic surgery group had an average operation time of 78.3 ± 24.51 min ( p < 0.05). The thoracoscopic surgery group had significantly lower intraoperative blood loss than the open surgery group ( p < 0.05). In addition, the duration of the postoperative thoracic drainage tube was 5.43 ± 0.76 days in the open surgery group, which was longer than the 2.38 ± 0.87 days in the thoracoscopic surgery group ( p < 0.05). Furthermore, the postoperative length of hospital stay was an average of 10.23 ± 1.43 days for the open surgery group, longer than for the thoracoscopic surgery group (4.36 ± 0.87 days) ( p < 0.05). Conclusions Thoracoscopic surgery has several advantages in the treatment of pediatric mediastinal neurogenic tumors and is worthy of clinical popularization and application. For giant mediastinal malignant neurogenic tumors, puncture biopsy and adjuvant chemotherapy can be performed before surgery to lessen the tumor volume and enlarge the operation space, which would reduce bleeding and complications.

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Enhanced Recovery After Gastrointestinal Surgery (ERAS) in Pediatric Patients: a Systematic Review and Meta-analysis

Cited by 51 publications

References 37 publications

The Development of an Enhanced Recovery Protocol for Kasai Portoenterostomy

The Development of an Enhanced Recovery Protocol for Kasai Portoenterostomy

Minimally Invasive Surgery for Orchidopexy in Children with Cryptorchidism: Reducing the Need for an Inguinal Incision

A single‐center study of thoracoscopic surgery in the treatment of pediatric mediastinal neurogenic tumors

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