Application of enhanced recovery after surgery for three-dimensional laparoscopic excision for choledochal cyst in children

Abstract

Objective To explore the clinical value of enhanced recovery after surgery (ERAS) for resecting laparoscopic choledochal cyst (CDC) in children. Methods Retrospective review was performed for the clinical data of 33 hospitalized children with a definite diagnosis of CDC. From April 2017 to October 2018, control group (n=18) received traditional treatment for CDC. From November 2017 to May 2018, another 15 patients were enrolled in ERAS group. All patients underwent three-dimensional laparoscopic choledochal cyst excision and Roux-en-Y hepatojejunostomy by the same pediatric surgeon group. Intraoperative blood loss, operative duration, rate of conversion into laparotomy, time for initial water intake, postoperative time to total enteral nutrition, postoperative hospital stay, total hospital expense, postoperative complications and readmission rate within 30 days were reviewed. Results Intraoperative blood loss, operative duration and rate of conversion into laparotomy showed no significant inter-group differences (P>0.05). Time to postoperative initial water intake, postoperative time to total enteral nutrition, postoperative hospital stay and total expense were (21.5±2.1) hours, (4.3±0.5) days, (5.3±0.6) days, (35945.49±6071.46) yuan in ERAS group versus (44.1±3.5) hours, (7.7±2) days, (9.1±2.5) days, (45609.08±11439.80) yuan in control group respectively. ERAS group was significantly less than control group (P<0.05). No significant inter-group differences existed in postoperative complications. Readmission within 30 days occurred in neither groups. Conclusions Perioperative ERAS scheme is effective for treating CDC. It can shorten postoperative hospital stay, relieve perioperative discomforts and relieve financial burden. Key words: Choledochal cyst; Laparoscopy; Enhanced recovery after surgery