Effect of an enhanced recovery after surgery-based multidisciplinary perioperative care pathway in children undergoing laparoscopic high ligation of the hernia sac.

AIM: To evaluate an enhanced recovery after surgery (ERAS)-based perioperative care pathway in children undergoing laparoscopic high ligation of the hernia sac.

METHODS

This prospective randomized controlled trial enrolled 120 children with inguinal hernia who underwent laparoscopic high ligation of the hernia sac between March 2023 and April 2024. Participants were randomly assigned to routine perioperative care (control group, n = 60) or routine care plus an ERAS-based multidisciplinary perioperative pathway (study group, n = 60). The primary outcome was postoperative hospital stay. Secondary outcomes were recovery of bowel sounds, time to first passage of flatus, time to first oral intake, in-hospital complications, and parental satisfaction. Pain, restlessness, PSQI, and Barthel Index measures were analyzed separately as purely exploratory outcomes.

RESULTS

Mean postoperative hospital stay was 4.26 days in the study group and 6.37 days in the control group [mean difference, -2.11 days; 95% confidence interval (CI), -2.53--1.69; Cohen's d = -1.82; P < 0.001]. Bowel-sound recovery, first passage of flatus, and first oral intake also occurred earlier in the study group, with mean differences of -1.42 h (95% CI, -1.99--0.85; d = -0.89), -2.03 h (95% CI, -2.84--1.22; d = -0.90), and -0.88 days (95% CI, -1.04--0.72; d = -2.02), respectively (all P < 0.001). The in-hospital complication rate was 1.67% versus 13.33%, corresponding to an absolute risk reduction of 11.67 percentage points (95% CI, 2.03-22.59), a relative risk of 0.13 (95% CI, 0.02-0.97), and a number needed to treat of 9. Parental satisfaction was 96.67% versus 83.33% (risk difference, 13.33 percentage points; 95% CI, 2.44-24.95; P = 0.015).

CONCLUSION

The ERAS-based multidisciplinary perioperative pathway was associated with shorter hospital stay, faster gastrointestinal recovery, fewer in-hospital complications, and greater parental satisfaction after laparoscopic high ligation of the hernia sac. Findings from the pain, restlessness, PSQI, and Barthel Index measures are purely exploratory.

CLINICAL TRIAL REGISTRATION: https://www.chictr.org.cn/, identifier ChiCTR2300071345.