WOFAPS 2025 8th World Congress of Pediatric Surgery

Michal Pasierbek ¹, Anna Modrzyk ¹, Dariusz Patkowski ², Katarzyna Rasiewicz ³, Monika Bukowska ⁴, Jerzy Machowski ⁵, Anna Ogorzalek ⁵, Artur Szymczak ⁵, Wojciech Gorecki ⁶, Joanna Godlewska ⁶, Karolina Tokarska ⁶, Przemysław Wolak ⁷, Aneta Piotrowska Gall ⁷, Lukasz Wladyszewski ⁷, Andrzej Golebiewski ⁸, Stefan Anzelewicz ⁸, Dominika Kosciuszko ⁸, Marzena Zielinska ⁹, Wojciech Korlacki ¹

¹ Department of Children's Developmental Defects Surgery and Traumatology, Medical University od Silesia, 41- 808 Zabrze, 3- Maja 13- 15, Poland
² Clinical Department of Paediatric Surgery and Urology, Wroclaw Medical University, Faculty of Medicine, 50-556 Wrocław, Borowska 213, Poland
³ Department of Pediatric Surgery and Urology, Wroclaw Medical University and Hospital, Borowska, Wroclaw, Poland
⁴ Department of Pediatric Surgery and Urology, Wroclaw Medical University, Wroclaw, Poland
⁵ Department of Pediatric Surgery and Urology, Clinical Hospital no 2 in Rzeszów, 35-310 Rzeszów, Lwowska 60, Poland
⁶ Department of Pediatric Surgery, Jagiellonian University Medical College, University Children’s Hospital of Krakow, 30- 663 Kraków, Wielicka 265, Poland
⁷ Faculty of Medicine, Collegium Medicum, Jan Kochanowski University of Kielce, 25-317 Kielce, Aleja IX Wieków Kielc 19A, Poland
⁸ Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk. 80- 803 Gdańsk, Nowe Ogrody 1-6, Poland
⁹ Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Department of Pediatric Anesthesiology and Intensive Care, University Hospital in Wroclaw, 50-556 Wrocław, Borowska 213, Poland

Purpose: To evaluate the outcomes of implementing a modified 22-element Enhanced Recovery After Surgery (ERAS) protocol in paediatric patients undergoing intestinal stoma closure across multiple tertiary centres in Poland.

Methods:
This multicentre prospective cohort study was conducted between 2022 and 2025 in six Polish paediatric surgical centres. Children under 18 years undergoing elective intestinal stoma closure were included, regardless of underlying diagnosis. Patients hospitalised outside paediatric surgical units or receiving total parenteral nutrition were excluded. A modified 22-element ERAS protocol was applied. A total of 206 patients (60,68% boys, 39,32% girls), aged 2 months to 17 years and 11 months, were included. Of these, 103 patients were managed according to the ERAS protocol (ERAS group). The control group (pre-ERAS group), also comprising 103 patients, was selected from the database using 1:1 propensity score matching.

Results:
In the ERAS group, 96,12% of patients avoided preoperative fasting compared with 24,27% in the pre-ERAS group. The “zero fluid balance” strategy, previously used in 6,8%, was adopted in 87,38% of ERAS patients. Parenteral nutrition use in postoperative period decreased from 74,51% to 27,18%. Median day of full oral tolerance was postoperative day 2 (ERAS) vs 5 (pre-ERAS). The first postoperative stool occurred on day 2 (ERAS) vs 3 (pre-ERAS). Median length of stay was reduced from 10 days (pre-ERAS) to 7 (ERAS). Similarly, the day of discharge postoperatively was reduced from 7 to 5 days (median).

Conclusions:
The implementation of the ERAS protocol in paediatric stoma closure surgery is both feasible and safe. The protocol led to measurable clinical improvements, including faster return of bowel function, reduced use of parenteral nutrition, shorter hospital stays, and earlier discharge.