Introducing enhanced recovery after surgery protocol in pediatric surgery

Background: Enhanced recovery after surgery (ERAS) is a holistic perioperative care protocol created to improve treatment outcomes. Implementation of new rules radically changed the perioperative care of adult patients. The protocol refers to the preoperative, intraoperative and postoperative periods. Objectives: To describe a novel pediatric ERAS protocol designed for reverse stoma surgery and to compare a group of patients with implemented ERAS protocol to a group of patients from pre-ERAS period. Material and methods: A retrospective comparative review was performed which included 14 patients from pre-ERAS period (2016-2017) and 13 patients in the ERAS period (2018-2019). Total parenteral nutrition (TPN) time, time to oral fluid intake, time to regular diet, time to stooling, and length of stay (LOS) were analyzed. Results: In the ERAS period, the LOS decreased from 8.64 to 6.08 days, time to oral fluid intake decreased from 4.36 to 1 postoperative day, time to regular diet decreased from 6.14 to 3.23 postoperative day. Total parenteral nutrition decreased from 5.14 in the pre-ERAS period to 1.69 days in the ERAS period. With the progress of implementation of ERAS protocol, TPN was gradually withdrawn. Conclusions: The implementation of the pediatric ERAS in children undergoing reverse stoma surgery is safe, reduces patient's metabolic stress and improves treatment outcomes. However, further research is needed.