Department of Surgery, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA.
Department of General Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Pediatr Surg Int. 2024 Nov 7;40(1):297. doi: 10.1007/s00383-024-05874-y.
The obesity epidemic has led to an increased number of adolescents requiring metabolic and bariatric surgery (MBS), but there is paucity of data on the impact of implementing all aspects of Enhanced Recovery After Surgery (ERAS) protocols to improve outcomes in this population.
We implemented a comprehensive ERAS pathway for adolescents undergoing laparoscopic sleeve gastrectomy (LSG). Key elements included pre-operative fasting with carbohydrate loading in the morning of surgery, comprehensive anti-emetic and analgesic regimens including intra-operative lidocaine infusion (initiated before formal ERAS launch), regional anesthesia, and early goal-directed ambulation. We tracked opioid utilization, rescue anti-emetic use, time to oral intake, and hospital length of stay (HLOS) as outcome measures, and post-operative pain and returns to the system as balancing measures.
Eighty-six patients (52 patients pre-ERAS and 34 patients post-ERAS) underwent LSG with no differences in demographics. The post-ERAS group had earlier time to oral intake (3.0 vs. 5.5 h, p = 0.003), used less rescue anti-emetics, (8.0 vs. 16.0 mg, p < 0.001), and had shorter HLOS (33 vs. 54 h, p < 0.001) but no difference in opioid use (0.370 vs. 0.435 MME/kg, p = 0.17), post-operative pain scores or return to the system.
Our novel use of bariatric-specific ERAS protocol with intra-operative lidocaine infusion accelerates the time to goal-directed oral intake and decreases HLOS without increasing the rate of returns to the system. This study highlights the feasibility and effectiveness of adapting adult ERAS protocols to the pediatric MBS population.
Level III.
肥胖症的流行导致越来越多的青少年需要接受代谢和减重手术（MBS），但关于实施强化术后康复（ERAS）方案的各个方面以改善该人群的结局的数据却很少。
我们为接受腹腔镜袖状胃切除术（LSG）的青少年实施了全面的 ERAS 方案。关键要素包括术前禁食，手术当天早上给予碳水化合物负荷，包括术中利多卡因输注（在正式启动 ERAS 之前开始）、区域麻醉和早期目标导向的活动。我们将阿片类药物的使用、止吐药物的使用、开始口服摄入的时间和住院时间（HLOS）作为结果指标，术后疼痛和返回系统作为平衡指标进行跟踪。
86 例患者（52 例 ERAS 前和 34 例 ERAS 后）接受了 LSG，两组患者的人口统计学特征无差异。ERAS 后组患者开始口服摄入的时间更早（3.0 小时与 5.5 小时，p=0.003），使用的止吐药物更少（8.0 毫克与 16.0 毫克，p<0.001），HLOS 更短（33 小时与 54 小时，p<0.001），但阿片类药物的使用无差异（0.370 与 0.435 MME/kg，p=0.17），术后疼痛评分或返回系统的情况也无差异。
我们创新性地使用了包含术中利多卡因输注的减重特异性 ERAS 方案，加速了达到目标导向口服摄入的时间，并缩短了 HLOS，而不会增加返回系统的比率。这项研究强调了将成人 ERAS 方案适应于儿科 MBS 人群的可行性和有效性。
III 级。
