Fast track versus conventional perioperative care protocols in paediatric intestinal stoma closure ‒ A randomised study

Abstract

Background: It is still unclear to what extent fast-track (FT) surgery is applicable in paediatric surgery. The aim of the study was to compare the outcome between FT and conventional perioperative care protocols in paediatric intestinal stoma closure to assess the safety for future application. Materials and Methods: This study was a prospective randomised study. Twenty-six paediatric patients who underwent intestinal stoma closure from December 2019 to March 2021 were divided into two groups: group A, conventional methods and Group B FT protocol. The FT protocol included minimal pre-operative fasting, no pre-operative bowel preparation, no routine intraoperative use of nasogastric tube, drain tube, urinary catheter, early post-operative enteral feeding, early mobilisation, non-opioid analgesics and prophylactic use of anti-emetic. Total length of post-operative hospital stays and complications between these two groups were compared. Results: No significant differences were found between the two groups regarding anastomotic leak (nil in both groups), wound infection (7.7% in Group A vs. 0% in Group B; P = 1.0) and wound dehiscence (7.7% in Group A vs. 0% in Group B; P = 1.0). No significant differences were found in post-operative length of stay (median 5, interquartile range [IQR] 4–9 in Group A and median 6, IQR 4–7 in Group B, P = 0.549) and time to appearance of bowel function (passage of stool) (median 2 days in both groups; P = 0.978). Conclusions: FT surgery was comparable to the conventional method in terms of complication and thus can reduce unnecessary interventions.

Keywords

• enhanced recovery after surgery
• fast-track protocols
• hospital stay
• intestinal stoma closure