Children assigned to an enhanced recovery after surgery (ERAS) pathway spent less time in hospital after laparoscopic hernia surgery than children receiving routine care in a randomized trial. The observed postoperative stay averaged 4.26 days in the ERAS group and 6.37 days in the routine-care group, a difference of 2.11 days. The 95% confidence interval for that difference was 1.69 to 2.53 days, and P was less than 0.001.
The prospective trial enrolled 120 children, assigning 60 to routine perioperative care and 60 to routine care plus the ERAS pathway. The pathway was multidisciplinary and brought together changes before, during and after surgery.
That headline result has a precise boundary. Hospital stay was measured from the end of surgery to actual discharge. The study did not use a prespecified, uniform checklist or threshold for deciding when a child was medically ready to leave, so the finding concerns observed discharge timing rather than time to a common readiness standard.
What the pathway changed
The package included shorter fasting and fluid restriction, oral glucose before surgery, active warming, short-acting analgesia, earlier oral intake, restrictive intravenous fluids and early mobilization. The comparison group received routine perioperative care.
Allocation was concealed in sequentially numbered, opaque, sealed envelopes opened only after enrollment. Children, parents and the clinical care team were unblinded, while independent outcome assessors and the data analyst were blinded. No child was lost after randomization, and all randomized children were included in the final analysis.
Baseline age and sex were comparable between groups. The children were 1 to 12 years old and were analyzed as one group, without prespecified age- or sex-stratified analyses or interaction testing. The cohort included 114 boys and six girls, limiting reliable sex-specific interpretation.
Signs of faster early recovery
Several measures of gastrointestinal recovery also favored the ERAS group. Bowel-sound recovery came 1.42 hours earlier, first passage of flatus came 2.03 hours earlier, and first oral intake came 0.88 days earlier. All three differences had P values below 0.001.
Not every perioperative measure changed. Blood loss was 0.58 mL lower and the operation was 1.61 minutes shorter on average in the ERAS group, but neither difference was statistically significant, with P values of 0.103 and 0.133, respectively.
In-hospital complications occurred in 1 of 60 children in the ERAS group (1.67%), compared with 8 of 60 (13.33%) in routine care. The absolute risk reduction was 11.67 percentage points, and the relative risk was 0.13, with a 95% confidence interval from 0.02 to 0.97. The reported number needed to treat was 9.
Parental satisfaction was 96.67% in the ERAS group and 83.33% in routine care, a difference of 13.33 percentage points. The study measured satisfaction with 19 items scored from 0 to 4; total satisfaction counted parents classified as satisfied or very satisfied.
The limits of the result
The result was limited to what happened in hospital. The trial followed children through discharge but did not schedule post-discharge follow-up, so its complication assessment did not show whether the hernia later recurred.
The bundle also means the trial does not show which individual change drove the observed differences. Participants, parents and the care team knew their assignments, although outcome assessors and the data analyst were blinded.
The trial's broad age range of 1 to 12 years was analyzed as one group, without prespecified age- or sex-stratified analyses or interaction testing. No a priori sample-size calculation was performed.
Transparency around the trial
The trial was registered at the Chinese Clinical Trial Registry under identifier ChiCTR2300071345. The study had institutional ethics approval, and written informed consent was obtained from parents or legal guardians.
The authors said no financial support was received for the work or its publication and reported no commercial or financial relationships that could be construed as potential conflicts.
Paper data and sources
Original title: Effect of an enhanced recovery after surgery-based multidisciplinary perioperative care pathway in children undergoing laparoscopic high ligation of the hernia sac
Authors: Zhou J, Wu Y, Lu D et al.
Journal/Repository: Frontiers in surgery
Status: Peer-reviewed
First online: 2026-10-10
DOI: Not available
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