Modified Enhanced Recovery After Surgery Protocols in Pediatric Gastric Transposition: Effects on Recovery and Outcomes

Introduction: Enhanced Recovery After Surgery (ERAS ® ) protocols aim to minimize surgical stress and accelerate recovery. In patients undergoing gastric transposition, modifications of ERAS ® may reduce complications, shorten hospital stay, and improve overall quality of life (QOL). Its application in pediatric esophageal replacement remains limited. We aimed to assess the outcomes of patients undergoing gastric transposition using a modified ERAS ® (mERAS ® ) protocol. Materials and Methods: This study included patients of long-gap Esophageal atresia/ Tracheo-esophageal fistula (EA/TEF) and pure esophageal atresia operated undergoing gastric transposition between January 2017 and May 2024. The retrospective group included patients managed with a conventional approach (non-ERAS ® group), and the prospective group was managed with mERAS ® bundles. The outcomes were compared, and QOL assessment was done using Quality of life of the infant (QUALIN) and Depression, Anxiety, and Stress Scale scores. Statistical analysis for categorical variables was done using the Chi-square/Fisher’s exact test. Nonparametric data were analyzed with the Wilcoxon rank-sum test. Results: The mERAS ® compliance was high. The mERAS ® group showed a statistically significant reduction in days of ventilation (2.08 vs. 6.43 days, P = 0.0420), intensive care unit stay (8.82 vs. 21.08 days, P = 0.016), and early start of feeding (2.75 vs. 7.15 days, P = 0.003). The length of hospital stay was shorter in the mERAS ® group (16.250 vs. 26.071 days, P = 0.037). There was a significant improvement in the QOL of infants and parental satisfaction score (80% mERAS ® vs. 28.57% non-ERAS ® group). Conclusion: Implementation of the mERAS ® protocol in gastric transposition surgery leads to early recovery, shorter hospitalization, improved QOL of infants, and improved satisfaction among the parents.