Efficacy analysis of enhanced recovery after surgery in laparoscopic-assisted radical resection of type I choledochal cyst
Authors: Zhang Bing , Wu Dianming , Bai Jianxi , Lin Sheng , Fang Xuejuan , Fang Yifan 
Published: February 2023

Abstract
Objective
To explore the feasibility and effectiveness of laparoscopic-assisted radical resection of type I choledochal cyst (CC) under the guidance of the concept of enhanced recovery after surgery (ERAS).
Methods
A total of 41 cases of children with type I CC admitted to our hospital from May 2020 to December 2021 were retrospectively analyzed, and the remaining 30 cases were screened according to inclusion and exclusion criteria, including 15 cases in the ERAS group and 15 cases in the traditional group. The operations of the two groups were performed by the same surgical team. Preoperative related data of the two groups of children were recorded respectively: gender, age, body weight, cyst size, C-reactive protein (CRP), preoperative albumin (ALB), alanine aminotransferase (ALT); intraoperative correlation Data: Opioid dosage, blood loss, operation time, rate of conversion to laparotomy; Relevant data after surgery: FLACC pain assessment scale results on the 1st, 2nd, and 3rd days after surgery, the time of gastric tube, urinary catheter and abdominal drainage tube removal, and the first defecation after surgery time, the time of first eating after surgery, the time to reach full food intake, the results of CRP, ALB, ALT on the 3rd and 7th postoperative day, postoperative complication rate, postoperative hospital stay, total hospitalization expenses and 30 day-to-day readmission rate. The relevant data of the two groups were statistically analyzed and compared.
Results
There was no significant difference between the ERAS group and the traditional group in the results of gender, age, body weight, cyst size, preoperative CRP, ALB, and ALT. There was no significant difference between the ERAS group and the traditional group in terms of intraoperative blood loss, operation time, and the number of cases converted to laparotomy; there was a statistically significant difference in the dose of opioids. There were statistically significant differences between the ERAS group and the traditional group in the results of the FLACC pain assessment scale on the 1st and 2nd day after surgery, the time of gastric tube, urinary catheter and abdominal drainage tube removal, the time of first defecation after operation, the time of first eating after operation, the time to reach full food intake, the results of CRP, ALB, and ALT on the 3rd and 7th postoperative day, postoperative hospital stay, and total treatment cost. There was no statistically significant difference between the ERAS group and the traditional group in the results of the FLACC pain assessment scale on the 3rd day after surgery, the incidence of postoperative complications and the rate of readmission within 30 days.
Conclusions
Under the guidance of the ERAS concept, children undergoing laparoscopic-assisted radical resection of type I CC have advantages over the traditional laparoscopic group in terms of opioid dose, time to first postoperative defecation, time to first postoperative feeding, time to reach full feeding, length of postoperative hospital stay, and total treatment cost. The ERAS concept is effective and safe for laparoscopic-assisted radical resection of type I CC.