| Objective:Based on the analysis of the data of pediatric congenital choledochal cyst from departments of pediatric surgery in China and discuss:The effectiveness and safety of enhanced recovery after surgery in the perioperative period of pediatric congenital choledochal cyst.Methods and materials:Using the medical record system and internet data system,a total of 122 children with congenital choledochal cyst who received Roux-en-Y hepaticojejunostomy in the First Affiliated Hospital of Zhengzhou University and other departments of pediatric surgery in China from september 2019 to january 2022 were analyzed.The data include:age in months,gender ratio,body weight,preoperative abdominal pain,preoperative fever,preoperative jaundice,preoperative white blood cells,red blood cells,alanine aminotransferase,aspartate aminotransferase,glutamyl transpeptidase,serum albumin,total bilirubin,prothrombin time,Todani classification,cyst shape,cyst imaging diameter,ASA classification,operation time,intraoperative blood loss,blood transfusion,first postoperative exhaust or defecation time,postoperative length of stay,complications,Clavien-Dindo classification and unplanned secondary operation.The patients were divided into enhanced recovery after surgery group and traditional group;according to the surgical approach,they were divided into laparotomy group and minimally invasive group.Traditional+laparotomy group,traditional+minimally invasive group,ERAS+ laparotomy group and ERAS+minimally invasive group were obtained by combining perioperative management and surgical approach.Results:1.According to the perioperative management,the case data of 122 children were divided into 2 groups,including 52 cases in the traditional group and 70 cases in the ERAS group.Monthly age,gender ratio,body weight,laboratory examination items,cyst shape,Todani classification,cyst imagine diameter,ASA classification,preoperative abdominal pain,fever,jaundice,operation time,and intraoperative blood loss,intraoperative blood transfusion cases,complications,the grade of complications and the unplanned secondary operation had no significantly differences(P>0.05).The median time of first postoperative exhaust or defecation was 3.0 days in the traditional group and 2.0 days in the ERAS group.The median postoperative length of stay in the traditional group was 10.0 days and ERAS group was 8.0 days,the above differences were statistically significant(P<0.001),The time of first exhaust/defecation and postoperative hospital stay in ERAS group was shorter than that in traditional group.2.According to the surgical approach,the case data divided into 2 groups,including 11 cases in the laparotomy group and 111 cases in the minimally invasive group.The difference in operation time between two groups was statistically significant(P=0.010).The median operation time in laparotomy group and minimally invasive group was 182.3 and 229.0 minutes.There was no significant difference in other perioperative data.3.Combining the perioperative management and surgical approach,it was divided into 5 cases in traditional+laparotomy group,47 cases in traditional+minimally invasive group,6 cases in ERAS+laparotomy group and 64 cases in ERAS+ minimally invasive group.There was no significant difference in age,gender ratio,body weight,laboratory examination items,cyst shape,Todani classification,cyst imaging diameter,ASA classification,preoperative abdominal pain,fever,jaundice,intraoperative blood loss,incidence of complications,grade of complications and unplanned secondary operation between groups(P>0.05).There were significant differences between groups in operation time,number of intraoperative transfusion cases,first postoperative exhaust/defecation time and postoperative length of stay(P<0.05).The operation time of four groups was 190.0 minutes,240.4±58.4 minutes,183.0 minutes and 215.0 minutes.The number of blood transfusion cases was 0,10,2,and 3,respectively.The median time of postoperative exhaust/defecation was 2.5 days,3.0 days,2.0 days and 2.0 days.The median time of postoperative length of stay was 13.0 days,10.0 days,10.0 days and 8.0 days.Compared with the other groups,the ERAS+minimally invasive group had shorter time to the postoperative exhaust/defecation and postoperative length of stay.4.Logistic univariate regression analysis was performed on the prolongation of postoperative length of stay and complications.The ERAS management was an independent protective factor for reducing the risk of prolonged postoperative length of stay(odd ratio 0.387,95%confidence interval 0.176-0.855,P=0.019).Higher ASA grade was an independent risk factor for increasing the risk of postoperative complications(odd ratio 2.550,95%confidence interval 1.020-6.372,P=0.045).Intraoperative blood loss greater than 20 ml was independent risk factor for prolonged postoperative length of stay(odd ratio 2.656,95%confidence interval 1.036-6.807,P=0.042)and increased risk of postoperative complications(odd ratio 3.171,95%confidence interval 1.217-8.258,P=0.018).Compared with the ERAS+minimally invasive group,the risk of prolonged postoperative length of stay was increased in each group,and the ratio between the traditional+minimally invasive group and the ERAS+minimally invasive group was statistically significant(odd ratio 2.420,95%confidence interval 1.068-5.482,P=0.034).Conclusion:1.It is safe and feasible to apply the concept of ERAS in the perioperative period of children with congenital choledochal cyst,which can shorten the postoperative length of stay and accelerate the recovery of gastrointestinal function without increasing the incidence of complications and aggravating the degree of complications.The advantage is more obvious when the ERAS managements combined with the minimally invasive surgical approach.2.Intraoperative blood loss greater than 20 mL is an independent risk factor for prolonged postoperative length of stay and higher ASA classification and intraoperative blood loss greater than 20 mL are independent risk factors for increased risk of postoperative complications. |
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