ERAS (Enhanced Recovery After Surgery) Protocol Improves Clinical Results Following Surgery for Choledochal Cysts in Children
Description
Aim: Enhanced Recovery After Surgery (ERAS) protocol is more commonly used in adult gastrointestinal surgery, but there is a limited number of studies focusing on the pediatric population. The aim of this study is to evaluate the effectiveness and reliability of ERAS in pediatric choledochal cyst surgery. Methods: Medical records of pediatric patients who underwent surgery for choledochal cysts between March 2008 and April 2023 were reviewed. Our clinic transitioned to the ERAS protocol in 2016. Twenty-one patients who underwent surgery between 2016 and 2023 and managed with the ERAS protocol were compared with 24 patients who underwent surgery between 2008 and 2015 without the ERAS protocol in terms of abdominal drain placement, time to first mobilization, time to achieve first and full enteral intake, and postoperative complications. Results: Following the implementation of the ERAS protocol, there was an increase in the use of minimally invasive surgical procedures and a decrease in the placement of drains. The median time to first eating 20 h (18-44) vs 42 h (18-76); p=0,003, time to first mobilization 8h (4-24) vs 18h (4-40); p=0,01, and hospital stay 3d (2-5) vs 5d (3-7); p=0,0001 were all found to be shorter in the ERAS group. No differences were observed between the two groups in terms of early postoperative complications (p=0,21). Conclusion: ERAS protocol is both effective and safe, facilitating faster recovery and earlier discharge without increasing the risk of early postoperative complications. Therefore, the ERAS protocol should be considered as a standard approach in the surgical management of pediatric choledochal cysts.