Enhanced Recovery After Surgery (ERAS) for Lower Urinary Tract Reconstruction in Children

Purpose of review Enhanced recovery after surgery (ERAS) is a fundamental shift in perioperative care that is designed to modulate the pathophysiologic response to stress and to minimize the fluid shifts from surgery. ERAS has consistently demonstrated an improved outcome for a wide variety of surgeries in adults but has only recently been explored in children. The purpose of this review is to describe the key elements of ERAS and their supporting evidence in the pediatric population, assess the literature on ERAS in lower urinary tract reconstruction, and discuss the strategies for implementation. Recent findings A majority of the literature is retrospective in nature and focuses on individual elements of ERAS in the pediatric population. More recent evidence has supported the avoidance of prolonged fasting and mechanical bowel preparation prior to surgery, use of regional anesthesia, and early feeding and avoidance of nasogastric decompression after surgery. Several small comparative studies with a well-defined enhanced recovery protocol have also observed a significantly shorter length of stay and significant decrease or no difference in the risk of postoperative complications for gastrointestinal surgery, lower urinary tract reconstruction, among others. A multi-disciplinary team, strong leadership, and continuous audit are all critical to implementation and sustainability of ERAS. Summary The current evidence is promising but still limited on ERAS for lower urinary tract reconstruction and other major surgeries in the pediatric population. Higher-quality studies are clearly needed to corroborate the findings of earlier studies and to allow for the refinement of pediatric-specific best practices and development of pediatric guidelines in the future.