Unnecessary Gastric Decompression in Distal Elective Bowel Anastomoses in Children: A Randomized Study

Dávila-Pérez, Roberto; Bracho-Blanchet, Eduardo; Tovilla-Mercado, José Manuel; Hernández-Plata, J.A.; Reyes‐López, Alfonso; Nieto-Zermeño, Jaime

doi:10.1007/s00268-010-0442-3

Cited by 18 publications

(4 citation statements)

References 28 publications

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“…Specifically, tumor histology and volume, preoperative bowel preparation, lymph node sampling and yield, operative time, blood loss, preoperative chemotherapy, and antibiotic prophylaxis were not significant with early discharge. Moreover, our findings are comparable with other similar studies, with limited use and early removal of various tubes, including nasogastric tubes (NGT), abdominal drains, and Foley's catheters facilitating the early mobilization, pain control and suggesting the abandonment of the routine use of postoperative NGT and abdominal drains [ 17 - 19 ].…”

Section: Discussionsupporting

confidence: 90%

Review of Perioperative Care Pathway for Children With Renal Tumors

Ali¹,

Latif²,

Sheikh³

et al. 2022

Cureus

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Introduction Wilms tumor is the most common (90%) renal tumor in children. With the recent advances survival rate approaches 90%. This study was designed to identify factors associated with early recovery and hospital discharge, a step forward in the future development of early recovery after surgery (ERAS) protocol in children. Methods A retrospective cohort study was conducted from May 2020 to February 2022 among children up to the age of 18-years with a diagnosis of primary malignant renal tumors who underwent radical nephrectomy. Baseline parameters (preoperative), intraoperative, and postoperative components were analyzed. A univariable and multivariable logistic regression model was used to identify the factors leading to early discharge. The data were entered into SPSS version 20 (IBM Inc., Armonk, USA), and a p-value ≤0.05 was statistically significant. Results A total of 44 patients with malignant renal tumors were managed with a mean age at diagnosis of 4.06±3.00 years. Twenty-six (59.1%) were male and 18 (40.9%) were female. All the patients received neoadjuvant chemotherapy. Wilms tumor was the most common pathology found in 41 (93.1%) patients; 19 (43.0 %) had stage I, 21 (47.7%) stage II, and four (9.1%) stage III disease. Thirty-four (77.3%) patients had a nasogastric tube placed postoperatively. Median blood loss (BL) was 40 ml (range: 5-250), and the median operative time was two hours (range: 1-4). The median postoperative day to mobilization was one day (range: 1-3), to clear liquids was two days (range: 1-3), and advanced to regular diet was three days (range: 2-5). The median postoperative day of discharge (from surgery to discharge) was four days (range: 2-7), with 31 (70.5%) patients discharged early. Conclusion Our findings indicate that early removal of tube, mobilization, and re-feedings were significantly associated with the early hospital discharge, while the other analyzed factors were not statistically significant. Furthermore, our findings are important in the future development and implementation of ERAS protocol in pediatric oncological resections.

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Section: Discussionsupporting

confidence: 90%

Review of Perioperative Care Pathway for Children With Renal Tumors

Ali¹,

Latif²,

Sheikh³

et al. 2022

Cureus

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“…Research has found that minimally invasive laparoscopic surgery has lesser interference on the intestines than traditional open surgery, and the gastrointestinal function can be returned to normal in 1–2 days postoperatively. Nasogastric tube is not routinely used unless delayed gastric emptying occurs ( 12 , 25 ). In addition, prolonged indwelling urinary tube not only increase the discomfort of children, but also increase the incidence of urinary tract infections.…”

Section: Discussionmentioning

confidence: 99%

Application of enhanced recovery after surgery during the perioperative period in children with Meckel’s diverticulum–a single-center prospective clinical trial

Wang,

Zhao

et al. 2024

Front. Pediatr.

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BackgroundEnhanced recovery after surgery (ERAS) has been widely used in adult surgery. However, few studies have reported the efficacy of ERAS in paediatric patients with Meckel's diverticulum (MD), the aim of the study was to prospectively evaluate the safety and efficacy of ERAS in treating MD.MethodsA prospective randomised controlled study of children with MD admitted to our hospital from Jan 1, 2021 to Dec 31, 2023 were conducted, we developed and implemented an ERAS program for this patients. All cases were strictly selected according to the inclusion and exclusion criteria. Among these patients, they were randomly assigned to the ERAS group or the traditional (TRAD) group with random number table row randomization. The main observational indicators were operation time, intraoperative hemorrhage, FLACC pain scale results on 2 h, 6 h, 12 h, 24 h after surgery, length of postoperative stay (LOPS), time to first defecation, time to first eating after surgery, time to discontinuation of intravenous infusion, total treatment cost, incidence of postoperative complications, 30-day readmission rate and parental satisfaction rate.ResultsA total of 50 patients underwent Meckel's diverticulectomy during this period, 7 patients were excluded, 23 patients were assigned to the ERAS group and 20 patients were assigned to the TRAD group. There were no significant differences in demographic data and operation time, intraoperative hemorrhage. The FLACC pain scale results on 2 h, 6 h, 12 h, 24 h after surgery were significantly lower in the ERAS group. The LOPS was 6.17 ± 0.89 days in the ERAS group and 8.30 ± 1.26 days in the TRAD group, resulting in a significantly shorter LOPS in ERAS group. ERAS could also reduce the first postoperative defecation time, the time to first eating after surgery and the time to discontinuation of intravenous infusion. The treatment cost was decreased in the ERAS group. The rate of complications and 30-day readmission were not significantly different between the two groups.ConclusionsIn this single-center study, the ERAS protocol for patients with MD requiring surgery was safe and effective.

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“…Even nasogastric intubation is not required postoperatively; in fact, it can be detrimental in surgeries involving distal bowel. [ 11 12 ] Postoperative fasting for 3–5 days often leads to a catabolic state, malnutrition, weight loss, and reduced immunity. [ 13 ] It causes severe discomfort to the children as they do not tolerate starvation for long periods like adults and increases parental anxiety.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Early Oral Feeding Compared to Delayed Feeding in Children after Elective Distal Bowel Anastomosis

Jayakumar,

Rathod,

Eradi

et al. 2023

Journal of Indian Association of Pediatric Surgeons

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A BSTRACT Background: Conventionally, oral feeds after distal bowel anastomosis surgery (ileostomy/colostomy closure) are delayed until after bowel peristalsis is established. The safety of an early feeding regimen is not established in children. This study compared early feeding regimens with delayed feeding in children undergoing elective intestinal anastomosis surgeries. Materials and Methods: In this retrospective multicentric cohort study, children undergoing elective distal bowel anastomosis surgery were divided into Group A (oral feeds allowed within 6 h) and Group B (delayed feeds). The two groups were compared for the incidence of abdomen distension, vomiting, surgical site infection, duration of analgesia, length of hospital stay, and readmission rate. Results: During the study, 58 patients were included: Group A ( n = 26) and Group B ( n = 32). The duration of analgesia (1.9 vs. 4.01 days) and length of hospital stay (3.38 vs. 5.0 days) were significantly less in Group A. Abdominal distension (7.7% vs. 15.6%), vomiting (11.5% vs. 15.6%), surgical site infection rate (3.8% vs. 12.5%), and readmissions (0% vs. 3.1%) were less in Group A, but statistically not significant. Conclusion: Early feeding after the elective restoration of distal bowel continuity can be safely practiced in the pediatric population. It is associated with a reduced need for analgesia and shorter hospital stay.

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Unnecessary Gastric Decompression in Distal Elective Bowel Anastomoses in Children: A Randomized Study

Abstract: The routine use of nasogastric drainage after distal elective intestinal surgery in children can be eliminated. Its use should depend on the individual patient's situation.

Cited by 18 publications

References 28 publications

Review of Perioperative Care Pathway for Children With Renal Tumors

Review of Perioperative Care Pathway for Children With Renal Tumors

Application of enhanced recovery after surgery during the perioperative period in children with Meckel’s diverticulum–a single-center prospective clinical trial

Outcomes of Early Oral Feeding Compared to Delayed Feeding in Children after Elective Distal Bowel Anastomosis

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