Liu Wenyue,Wu Xiaoxia,Zhao Baohong,et al.Application of enhanced recovery after surgery in infants with anal atresia with rectovestibular fistula[J].Journal of Clinical Pediatric Surgery,,21():1029-1034.[doi:10.3760/cma.j.cn101785-202201040-006]
Application of enhanced recovery after surgery in infants with anal atresia with rectovestibular fistula
- Keywords:
- Anorectal Malformations; Anus; Imperforate; Rectal Fistula; Minimally Invasive Surgical Procedures
- Abstract:
- Objective To explore the efficacy and safety of enhanced recovery after surgery (ERAS) in children with anal atresia and rectal vestibular fistula.Methods From January 2017 to October 2021, prospective review was conducted for 50 children with anal atresia and rectal vestibular fistula undergoing transanal analoplasty.They were randomized into two groups of ERAS and non-ERAS (n=25 each).ERAS group received enema once in the morning of operation day, oral 12.6% carbohydrate liquid 2 h pre-operation, intraoperative heat preservation, target-oriented rehydration, no indwelling catheter post-operation, postoperative analgesia and other new measures;non-ERAS group had traditional perioperative treatment.Blood glucose at the beginning of anesthesia, blood glucose 24 h post-operation, white blood cell count (WBC), C-reactive protein (CRP), time of initial exhaust and defecation post-operation, amount of intraoperative infusion, time of postoperative intravenous infusion, time of postoperative hospitalization, expenditure of hospitalization, incidence of complications and readmission rate at Day 30 post-discharge were compared between two groups.Results No significant inter-group differences existed in average age, weight, preoperative WBC, CRP, hemoglobin, albumin, prealbumin or blood glucose at admission.Blood glucose at the beginning of anesthesia in ERAS and non-ERAS groups was (4.92±0.50) and (4.53±0.42) mmol/L, blood glucose (5.03±0.66) and (5.96±1.18) mmol/L at 24 h post-operation.WBC at 24h post-operation (9.97±3.24)×109/L and (8.28±3.51)×109/L;CRP at 24 h post-operation (3.63±4.00) and (9.03±15.77) mg/L;initial postoperative exhaust and defecation time (12.1±6.4) and (14.0±9.3) h;intraoperative infusion volume (83.1±32.2) and (136.1±68.4) mL;postoperative intravenous infusion time (4.68±1.25) and (6.6±1.68) days;postoperative hospital stay (7.12±1.56) and (10.56±3.58) days;hospitalization expense (13 314.34±2 856.86) and (16 088.69±3 282.34) CNY;complications occurred (n=3, 12%) and (n=6, 24%);overall satisfaction was 88% and 60%.Both groups were cured and discharged and there was no re-admission within 30 days post-discharge.No inter-group differences existed in initial exhaust or defecation time, WBC and CRP at 24 h post-operation (P>0.05).In non-ERAS group, blood glucose declined at the beginning of anesthesia while postoperative blood glucose level rose with statistical difference (P<0.05);overall satisfaction of ERAS group was higher than that of non-ERAS group with statistical difference (P<0.05).Conclusion Conceptual application of ERAS is both safe and effective in children with anal atresia with rectovestibular fistula.It can effectively shorten the average time of hospital stay, curtain the length of postoperative hospitalization and lower hospitalization expenditure.A wider popularization is worthy.
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Memo
收稿日期:2022-01-18。
基金项目:山西省儿童医院院内课题项目（202055）
通讯作者:任红霞,Email:renhongxia100@sina.com