EC Paediatrics

Background: The ERAS program has only recently been applied to children, with the main obstacle being the complexity of pediatric surgeries. Children have their own unique physiological response to surgery, including being more vulnerable to dehydration and hypothermia, having a lower tolerance for intraoperative blood loss, and an increased risk of anesthesia complications. However, the use of ERAS has been limited in the pediatric population due to a clear lack of evidence. We have used components of ERAS in our pediatric patients undergoing surgery for Hirschsprung disease.

Purpose of the Study: To evaluate the safety and efficacy of accelerated surgery (ERAS) combined with laparoscopy in the treatment of Hirschsprung disease in children.

Material and Methods of Research: The study was conducted on 76 children with Hirschsprung's disease who underwent elective surgery with bowel pull-down in the period from 2011 to 2024 in the surgical clinic and in the bases of the AMU. The patients were divided into two groups: the ERAS program combined with laparoscopy (study group, n = 38) and the laparoscopic surgery with conventional perioperative management (control group, n = 38). Postoperative bowel function recovery, hospital stay, hospital costs, complications were compared, and postoperative recovery was monitored for four weeks.

Research Results: There were no significant differences in intraoperative blood loss and operative time between the ERAS group and the control group (both P > 0.05). Recovery of bowel movements occurred earlier in the ERAS group, but the difference was not statistically significant (P = 0.062). Hospital stay was shorter [(5,77 ± 0,8) days versus (14,2 ± 2,8) days], and hospitalization costs were significantly lower in the study group than in the control group.

Conclusion:

1. The ERAS protocol is applicable to pediatric Hirschsprung disease surgeries with shorter hospital stay and fewer complications, especially in the form of SSI. We recommend using the maximum number of components based on our experience to obtain optimal results.
2. Accelerated surgery combined with laparoscopy in the treatment of Hirschsprung's disease in children is safe and effective.

 Keywords: ERAS; Hirschsprung Disease; Caudal Block

1. Gołębiewski A., et al. “Transanal endorectal pull-through for Hirschsprung's disease: complications and lessons from our practice and the literature”. Children (Basel)9 (2024): 1059.
2. Purcell LN., et al. “An enhanced recovery after surgery pathway in pediatric colorectal surgery improves patient outcomes”. Journal of Pediatric Surgery 1 (2021): 115-120.
3. Short HL., et al. “Implementation of an enhanced recovery protocol in pediatric colorectal surgery”. Journal of Pediatric Surgery 4 (2018): 688-692.
4. Zhang XW., et al. “Application of enhanced recovery after surgery in the perioperative period of pediatric colonic lesions”. Chinese Journal of General Practice 18 (2020): 358-361,475.
5. Zhou XB., et al. “Application of enhance recovery after surgery in pediatric selective colorectal surgery”. Chinese Journal of General Practice 28 (2019): 247-251.
6. Dagorno C., et al. “Enhancing recovery after minimally invasive surgery in children: a systematic review of the literature and meta-analysis”. Journal of Pediatric Surgery12 (2021): 2157-2164.
7. Ljungqvist O., et al. “The history of enhanced recovery after surgery and the ERAS society”. Journal of Laparoendoscopic and Advanced Surgical Techniques 9 (2017): 860-862.
8. Gao R., et al. “Enhanced recovery after surgery in pediatric gastrointestinal surgery”. Journal of International Medical Research 10 (2019): 4815-4826.
9. Yeh A., et al. “ERAS protocol for pediatric laparoscopic cholecystectomy promotes safe and early discharge”. Journal of Pediatric Surgery 1 (2020): 96-100.
10. Kehlet H and Wilmore DW. “Evidence-based surgical care and the evolution of fast-track surgery”. Annals of Surgery 2 (2008): 189-198.