Zhu K, Zhang X, Li Y, Gao Y, Tong YM, He JJ, Su YL. Enhanced recovery after surgery protocol implementation in pediatric Meckel’s diverticulum resection: A clinical outcome study. World J Gastrointest Surg 2025; 17(12): 113407 [DOI: 10.4240/wjgs.v17.i12.113407]
Corresponding Author of This Article
Yi-Lin Su, MD, Director, Professor, Department of Pediatric Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Luyang District, Hefei 230001, Anhui Province, China. zk030405@163.com
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Surgery
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Retrospective Cohort Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 27, 2025 (publication date) through Dec 25, 2025
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Publication Name
World Journal of Gastrointestinal Surgery
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1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Zhu K, Zhang X, Li Y, Gao Y, Tong YM, He JJ, Su YL. Enhanced recovery after surgery protocol implementation in pediatric Meckel’s diverticulum resection: A clinical outcome study. World J Gastrointest Surg 2025; 17(12): 113407 [DOI: 10.4240/wjgs.v17.i12.113407]
World J Gastrointest Surg. Dec 27, 2025; 17(12): 113407 Published online Dec 27, 2025. doi: 10.4240/wjgs.v17.i12.113407
Enhanced recovery after surgery protocol implementation in pediatric Meckel’s diverticulum resection: A clinical outcome study
Kai Zhu, Xiao Zhang, Yan Li, Yan Gao, Yong-Mei Tong, Jing-Jing He, Yi-Lin Su
Kai Zhu, Xiao Zhang, Yan Li, Yan Gao, Yong-Mei Tong, Yi-Lin Su, Department of Pediatric Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
Jing-Jing He, Department of Reproductive Medicine Center, Hefei Maternal and Child Health Hospital, Hefei 230001, Anhui Province, China
Co-first authors: Kai Zhu and Xiao Zhang.
Co-corresponding authors: Jing-Jing He and Yi-Lin Su.
Author contributions: Zhu K, Zhang X, and Su YL designed the research protocols and drafted the manuscript; Zhu K and Su YL conceptualized and initiated the study; Li Y, Gao Y, and Tong YM conducted medical record collection and statistical analysis; He JJ and Su YL performed data interpretation; Zhu K and Zhang X contributed equally to this manuscript and are co-first authors; He JJ and Su YL contributed equally to this manuscript and are co-corresponding authors. All authors critically reviewed and approved the final manuscript.
Institutional review board statement: The study was approved by The Ethics Board of the First Affiliated Hospital of University of Science and Technology of China (Approval No. 2025-RE-385).
Informed consent statement: Written informed consent for participation was obtained from the legal guardians of the participants.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets generated and analyzed during this study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi-Lin Su, MD, Director, Professor, Department of Pediatric Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Luyang District, Hefei 230001, Anhui Province, China. zk030405@163.com
Received: August 25, 2025 Revised: September 22, 2025 Accepted: November 6, 2025 Published online: December 27, 2025 Processing time: 122 Days and 11.7 Hours
Abstract
BACKGROUND
Enhanced recovery after surgery (ERAS) guidelines have been established for multiple types of adult surgeries. However, ERAS guidelines tailored to pediatric surgeries remain to be developed.
AIM
To evaluate the clinical outcomes of ERAS protocols in pediatric laparoscopic Meckel’s diverticulum resection.
METHODS
This retrospective cohort study analyzed 78 consecutive pediatric cases treated between January 2017 and March 2025. Patients were divided into: Traditional care group (n = 38): January 2017-December 2020; ERAS protocol group (n = 40): January 2021-March 2025. We compared perioperative outcomes, including clinical recovery parameters and laboratory markers, to assess protocol efficacy.
RESULTS
All procedures were completed laparoscopically by the same surgical team without conversion. Baseline characteristics, including demographics, diverticulum location, and intraoperative parameters (operative time, blood loss), were comparable between groups (all P > 0.05). The ERAS protocol demonstrated significantly shorter postoperative length of stay (7.55 ± 1.52 days vs 10.40 ± 3.59 days, P < 0.001) while complication rates were numerically lower in the ERAS group (17.50% vs 13.16%, P = 0.595). Additional benefits of ERAS implementation included: Reduced intravenous fluid requirements (5.00 mL/kg/hour vs 8.00 mL/kg/hour), accelerated gastrointestinal recovery (first flatus: 2.00 days vs 3.00 days), lower pain scores (P < 0.001), earlier total enteral nutrition achievement (5.00 days vs 6.50 days) and shorter intravenous therapy duration (6.00 days vs 8.00 days; all P < 0.001). ERAS patients also showed reduced drainage utilization (P < 0.05) and improved inflammatory marker profiles postoperatively [neutrophils: (5.98 ± 2.02) × 109/L vs (8.01 ± 3.98) × 109/L]; median C-reactive protein: 13.6 mg/L 7 vs 19.63 mg/L). Glycemic control was superior in the ERAS group despite higher induction levels (both P < 0.05). Parental satisfaction (92.50% vs 86.84%) and 30-day readmission rates (2.50% vs 2.63%) showed no significant differences.
CONCLUSION
ERAS protocols safely optimize recovery in children undergoing laparoscopic Meckel’s diverticulum resection, significantly reducing length of stay while improving pain management and overall clinical outcomes. These findings support the adoption of ERAS in pediatric intestinal surgery.
Core Tip: Our study provides compelling evidence that enhanced recovery after surgery (ERAS) protocol implementation is both safe and clinically beneficial for young children undergoing laparoscopic resection of Meckel’s diverticulum. Importantly, our subgroup analyses revealed a significant differential response to ERAS implementation based on surgical technique, as evidenced by substantially greater reductions in postoperative length of stay among patients who underwent segmental intestinal resection compared to those receiving wedge resection. These findings underscore the critical importance of tailoring ERAS protocols to specific surgical procedures, with maximal benefits being achieved in more complex resections.
