Application of enhanced recovery after surgery in the perioperative period of pediatric enterostomy closure

doi:10.4240/wjgs.114182

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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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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. Aug 27, 2026; 18(8): 114182
Published online Aug 27, 2026. doi: 10.4240/wjgs.114182

Application of enhanced recovery after surgery in the perioperative period of pediatric enterostomy closure

Kai Zhu, Feng Zhang, Wang-Wang Ou, Yan Ke, Zhen-Ying Zhu, Xiao-Man Tan, Hui Wang, Chuan-Cheng Sun, Heng-Fei Gao, Yi-Lin Su

Kai Zhu, Feng Zhang, Chuan-Cheng Sun, Heng-Fei Gao, 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

Wang-Wang Ou, Yan Ke, Zhen-Ying Zhu, Xiao-Man Tan, Hui Wang, Pediatric Surgical Nursing Unit, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China

Co-first authors: Kai Zhu and Feng Zhang.

Co-corresponding authors: Heng-Fei Gao and Yi-Lin Su.

Author contributions: Zhu K and Zhang F designed the research protocols and drafted the manuscript; Zhu K and Su YL conceptualized and initiated this study; Ou WW, Ke Y, Zhu ZY, Tan XM, Wang H and Gao HF collected medical records and performed statistical analysis; Sun CC and Gao HF interpreted the data; Zhu K and Zhang F contributed equally to this work and serve as co-first authors. Gao HF and Su YL contributed equally to this work and serve as co-corresponding authors. All authors have critically reviewed and approved the final version of the manuscript. Su YL conceptualized and initiated this study, constructed the overall research framework, supervised the study design and implementation, and participated in manuscript revision and academic optimization. Gao HF was mainly responsible for data interpretation, guided statistical analysis and result rational discussion, revised the core academic content of the manuscript, polished the academic logic and expression. Both Su YL and Gao HF made equally important, independent and indispensable academic contributions to the conception, implementation, data analysis, result interpretation and finalization of the manuscript. Therefore, it is reasonable and academically appropriate to set them as co-corresponding authors.

AI contribution statement: No AI tools including ChatGPT, Grammarly, DeepL and any other similar software were used throughout the preparation of this manuscript. The full text and any part of the main content of the manuscript, including Abstract, Introduction, Materials and Methods, Results, Discussion and Conclusion, are all independently completed by the authors, without any AI-generated content. We did not employ any AI tools for manuscript translation, data analysis or writing assistance. No AI tool was involved in the study design, data analysis and result interpretation of this research. All figures and images in the manuscript are originally produced by the authors, with no AI-generated pictures included.

Institutional review board statement: The study protocol was formally approved by the Ethics Review Board of the First Affiliated Hospital of the USTC (No. 2025-RE-386).

Informed consent statement: Given the retrospective, observational study design and full anonymization of patient data, the requirement for informed consent from patients or their legal guardians was waived by the Institutional Review Board.

Conflict-of-interest statement: All authors declare that they have no competing financial or non-financial interests to disclose related to this work.

Data sharing statement: The full dataset underpinning the findings of this study is curated and retained by the corresponding author. De-identified data will be made accessible to qualified researchers upon receipt of a scientifically meritorious request, subject to institutional data governance policies.

Corresponding author: Yi-Lin Su, MD, Chief Physician, 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: September 16, 2025
Revised: December 28, 2025
Accepted: May 15, 2026
Published online: August 27, 2026
Processing time: 336 Days and 19.8 Hours

Abstract

BACKGROUND

Enhanced recovery after surgery (ERAS) protocols have improved perioperative outcomes in adults. However, we know less about their use in pediatric enterostomy closure and this area still has no specific guidelines.

AIM

To see how well ERAS pathways, when adjusted for children, work during the whole perioperative period of enterostomy closure surgery.

METHODS

This is a single-center retrospective analysis conducted in a tertiary pediatric surgery department. It included 61 children who received enterostomy closure from January 2017 to December 2024, covering both the periods before and after ERAS protocol application. Patients were divided into two groups in this study. A total of 31 children treated by standardized pediatric ERAS protocols between 2021 and 2024 were assigned to the ERAS group. The other 30 patients received routine traditional perioperative management from 2017 to 2020 were comprised the traditional (TRAD) group. The main observational indicators included postoperative length of stay (LOS), pain scores within 48 hours after surgery and parental satisfaction. Secondary outcomes included perioperative metabolic, nutritional and inflammatory indicators, as well as the recovery of gastrointestinal function recovery metrics, indwelling catheter utilization/durations, surgical complications, hospitalization costs, 30-day unplanned readmission rate, and preoperative weight restoration at 30 days postoperatively.

RESULTS

Compared with the TRAD group, children in the ERAS group had a shorter median postoperative LOS (8.00 days vs 10.00 days, P < 0.001) and markedly lower Face, Legs, Activity, Cry, Consolability pain assessment scale pain scores within 48 hours after surgery (P < 0.001). In addition, parental satisfaction was significantly higher in the ERAS group (96.77% vs 73.33%, P < 0.05). The ERAS children had higher blood glucose at anesthesia induction, which decreased significantly by postoperative day 2 (both P < 0.05). They also showed higher serum prealbumin and lower C-reactive protein and neutrophil levels (all P < 0.05). ERAS significantly accelerated gastrointestinal recovery in children. Patients had earlier intestinal exhaust, sooner resumption of liquid and full enteral feeding, and required shorter intravenous infusion time (all P < 0.001). ERAS decreased perioperative catheter use, with shorter indwelling time and lower utilization of nasogastric tubes, urinary catheters and abdominal drains (all P < 0.05). The ERAS group had significantly lower mean hospitalization costs (¥14542.87 vs ¥19030.64, P < 0.001). Safety was comparable between the two groups, with no significant differences in surgical complication rates (19.36% vs 16.67%), 30-day unplanned readmissions (3.23% vs 3.33%), or 30-day preoperative weight recovery (80.65% vs 73.33%) (all P > 0.05).

CONCLUSION

ERAS protocols tailored for children are safe and practical for perioperative care in pediatric enterostomy closure. Adopting this approach helps enhance postoperative recovery, optimize nutritional and inflammatory indicators, and improve parental satisfaction, while maintaining overall patient safety. We therefore recommend routine clinical application of ERAS protocols for this high-risk pediatric surgical population.

Keywords: Enhanced recovery after surgery; Enterostomy closure; Perioperative care; Multimodal analgesia; Surgical rehabilitation

Core Tip: Our findings confirm that enhanced recovery after surgery (ERAS) application is safe and clinically beneficial for preschool children undergoing enterostomy closure. The clinical benefits were more prominent in colostomy reversal compared with small bowel stoma closure. It may be because colostomy patients follow ERAS protocols more steadily. Also, when patients stuck more closely to the ERAS guidelines, their recovery after surgery went better. This link shows a clear dose response pattern.