Advancing enhanced recovery after surgery protocols for pediatric laparoscopic-assisted small intestinal malformation repair.

PURPOSE: This study aimed to evaluate the safety and efficacy of enhanced recovery after surgery (ERAS) protocols in pediatric patients undergoing laparoscopic-assisted resection for Meckel’s diverticulum (MD) or intestinal duplication (ID). METHODS: A retrospective cohort analysis was conducted on 96 pediatric patients who underwent laparoscopic-assisted resection for MD or ID at our institution between January 2017 and July 2025, covering the periods pre- and post-ERAS implementation. Patients were stratified into two groups: the ERAS group (n = 49), managed per ERAS protocols, and the traditional (TRAD) group (n = 47), receiving conventional perioperative care. Demographic characteristics, perioperative outcomes, and laboratory parameters were systematically compared between groups. RESULTS: All procedures were performed by a consistent surgical team, with no significant differences in baseline characteristics between groups (all P > 0.05). The ERAS group exhibited superior outcomes: (1) Recovery: shorter median postoperative length of stay (LOS) (7.00 vs. 9.00 days, P < 0.001) and consistently lower FLACC pain scores at 2–48 h postoperatively (P < 0.001); (2) Laboratory markers: comparable preoperative values (all P > 0.05), but higher glucose levels at anesthesia induction (P < 0.001) and favorable postoperative laboratory profiles (lower C-reactive protein [CRP], neutrophil [NEUT] count, and glucose; higher prealbumin; all P < 0.05); (3) Clinical benefits: reduced urinary catheter utilization and duration (both P < 0.05), accelerated achievement of recovery milestones (mobility, flatus, oral intake, total enteral nutrition initiation, and intravenous infusion cessation; all P < 0.001), and lower healthcare costs (P < 0.001) without compromising safety (complication and readmission rates, both P > 0.05). ERAS-related advantages were more pronounced, with a non-significant trend toward higher parental satisfaction (P = 0.444). CONCLUSIONS: ERAS protocols safely optimize recovery in pediatric patients undergoing laparoscopic-assisted resection for small intestinal malformations (MD/ID) without adversely affecting clinical outcomes.